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Shahid Khan M, Alamgir Kabir M, Mohammad Tareq S. Socio-economic status and autism spectrum disorder: A case-control study in Bangladesh. Prev Med Rep 2024; 38:102614. [PMID: 38375167 PMCID: PMC10874876 DOI: 10.1016/j.pmedr.2024.102614] [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: 05/06/2023] [Revised: 01/01/2024] [Accepted: 01/13/2024] [Indexed: 02/21/2024] Open
Abstract
There are unexpectedly a few statistics about the socio-economic status (SES) and related socio-demographic factors (SDFs) of parents having child with ASD in Bangladesh. The prevalence of ASD might correlate with SES and related SDFs. A case-control study was conducted in 24 locations across 21 districts, encompassing all divisions, to assess the association between SES and the risk of developing ASD in Bangladesh. The structured questionnaire was administered through face-to-face interviews with 620 parents of the subject (310 ASD and 310 healthy controls) from January 2020 to June 2021. For univariate, bivariate and multivariate analyses, IBM SPSS version 23 was employed. The significance level was set at P ≤ 0.05, and the Odds Ratio (OR) within a 95 % CI was used to determine whether the variable poses a higher odd or not. After adjusting all significant covariates of binary logistic regression (including some dummy variables) in forward logistic regression model analysis, the higher level of SES, advanced level of father's education (≥master), 22-35 years old age group of the father, and nuclear family were strongly associated with decreased odds of ASD compared to healthy controls. Only the male gender was strongly associated with an increased odds of ASD compared to the control. The results will aid policymakers in developing plans considering the SES and related SDFs that influence the risk of developing ASD in Bangladesh. Further research using population-based cohorts or nested case-control designs with matched control is necessary to observe and generalize the association.
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Affiliation(s)
- Md. Shahid Khan
- Department of Environmental Sciences, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | | | - Shafi Mohammad Tareq
- Department of Environmental Sciences, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
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2
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Mårland C, Nilsson T, Larsson H, Gillberg C, Lubke G, Lundström S. Measuring autism in males and females with a differential item functioning approach: Results from a nation-wide population-based study. Psychiatry Res 2022; 314:114674. [PMID: 35716480 DOI: 10.1016/j.psychres.2022.114674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 12/27/2022]
Abstract
Existing screening instruments for Autism Spectrum Disorder (ASD) might be prone to detect a male manifestation of ASD. Here, we examined the 17 items from the ASD domain in the Autism-Tics, ADHD and other Comorbidities inventory (A-TAC) for Differential Item Functioning (DIF). Data were obtained from the Child and Adolescent Twin Study in Sweden (CATSS) in which parents have responded to the A-TAC. Information regarding a registered diagnosis of ASD were retrieved from the National Patient Register. The cohort was divided into a developmental sample for evaluation of DIF, and a validation sample for examination of the diagnostic accuracy of the total ASD domain, and a novel male and female short form. Our main finding included the identification of DIF for six items, three favouring males and three favouring females. The full, 17 item, ASD domain and the male and female short form showed excellent ability to capture ASD diagnoses in both males and females up to the age of nine years. The full ASD domain in A-TAC is psychometrically largely equivalent across sex and the limited differences between males and females diminish the need for a sex-specific scoring when utilizing the 17 item total score.
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Affiliation(s)
- Caroline Mårland
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rågården hus 1, SU- Östra Sjukhuset, Gothenburg 416 85, Sweden.
| | - Thomas Nilsson
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rågården hus 1, SU- Östra Sjukhuset, Gothenburg 416 85, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karoliska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Gitta Lubke
- Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Sebastian Lundström
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Rågården hus 1, SU- Östra Sjukhuset, Gothenburg 416 85, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Mesbah N, Marsousi V, Eslamian L, Montazerlotfelahi H, Shamshirsaz AA, Hessami K, Jamal A, Noorzadeh M, Naemi M, Ghaemi M. Infantile neurodevelopmental outcome after fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome: the first prospective experience from Iran. BMC Pregnancy Childbirth 2022; 22:458. [PMID: 35650560 PMCID: PMC9158318 DOI: 10.1186/s12884-022-04793-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022] Open
Abstract
Objective We sought to evaluate the neurodevelopmental outcomes at 12 months of age among infants with twin-to-twin transfusion syndrome (TTTS) undergoing fetoscopic laser photocoagulation (FLP). Materials and methods In this prospective longitudinal study, neurodevelopmental assessment was performed among the infants at the corrected age of 12 months, who were diagnosed with TTTS and treated by FLP. The Ages and Stages Questionnaire (ASQ) was filled out by parents. In the next step in infants with abnormal ASQ, motor and cognitive developments were evaluated by Bayley’s infant and toddler development scoring system (Bayley 3-Third edition). Results In 39 FLP procedures the rate of live birth of at least one twin was 73.8%. Four neonatal deaths were recorded, three of which were due to prematurity and one was due to heart anomaly. The ASQ was normal in 89.7% (35/39) of the infants (group I), 5.1% (2/39) had minor neurodevelopmental impairment (NDI) (group II), and 5.1% (2/39) had major NDI (group III). The 4 infants with abnormal ASQ had Bayley examination which showed two with mild to moderate cerebral palsy and two had delayed verbal skills and autistic spectrum disorder. No significant difference was noted between survivors with and without NDI with respect to donor or recipient status, birth weight, gestational age at birth, Quintero stage of TTTS. In addition, the relationship between gestational age at the time of undergoing FLC and NDI was not significant. Conclusion In our population, minor and major neurodevelopmental impairment were seen in 10.2% of the infants. This information is useful for counseling our couples in this population prior the procedure.
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Affiliation(s)
- Nazila Mesbah
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajiheh Marsousi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
| | - Laleh Eslamian
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Montazerlotfelahi
- Department of Pediatrics, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Alireza A Shamshirsaz
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kamran Hessami
- Maternal Fetal Care Center, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ashraf Jamal
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Noorzadeh
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahsa Naemi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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4
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Lundström S, Taylor M, Larsson H, Lichtenstein P, Kuja-Halkola R, Gillberg C. Perceived child impairment and the 'autism epidemic'. J Child Psychol Psychiatry 2022; 63:591-598. [PMID: 34363395 DOI: 10.1111/jcpp.13497] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The prevalence of diagnosed Autism Spectrum Disorder (ASD) has increased substantially across the world. Much - or even most - prevalence increase seems to reflect changes in diagnostic practice and ascertainment. A key part of ASD assessment is to document that the relevant symptoms are associated with clinical impairment. The aim of the present study is to capitalize on a nationwide longitudinal study spanning 15 consecutive birth year cohorts in order to investigate whether there has been a secular change in how parents perceive the impairment and suffering conferred by autism symptomatology in their children. METHODS Data came from the Child and Adolescent Twin Study in Sweden (27,240 individuals), where parents had reported on their child's ASD symptoms and impairment. Impairment due to ASD symptoms was regressed on an ASD symptom score across time. This was done for five 3-year birth cohorts (1995-1997, 1998-2000, 2001-2003, 2004-2006, and 2007-2009). RESULTS Reported impairment increased with consecutively later birth cohorts. This was evident across all levels of autism symptomatology. At clinically relevant levels of symptomatology, parents of those born 2007-2009 reported a 23% higher degree of impairment as compared with parents of those born in 1995-1997. The relative difference, however, was even greater at levels that previously would have been considered below the diagnostic threshold. DISCUSSION The results presented here contribute to the notion of a growing diffuseness in the conceptualization of the ASD diagnosis by adding the element of secular changes in the parental perception of the consequences of ASD symptom expression.
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Affiliation(s)
- Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Center for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mark Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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5
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Grivas G, Frye R, Hahn J. Pregnant Mothers' Medical Claims and Associated Risk of Their Children being Diagnosed with Autism Spectrum Disorder. J Pers Med 2021; 11:950. [PMID: 34683092 PMCID: PMC8537202 DOI: 10.3390/jpm11100950] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/13/2021] [Accepted: 09/21/2021] [Indexed: 12/11/2022] Open
Abstract
A retrospective analysis of administrative claims containing a diverse mixture of ages, ethnicities, and geographical regions across the United States was conducted in order to identify medical events that occur during pregnancy and are associated with autism spectrum disorder (ASD). The dataset used in this study is comprised of 123,824 pregnancies of which 1265 resulted in the child being diagnosed with ASD during the first five years of life. Logistic regression analysis revealed significant relationships between several maternal medical claims, made during her pregnancy and segmented by trimester, and the child's diagnosis of ASD. Having a biological sibling with ASD, maternal use of antidepressant medication and psychiatry services as well as non-pregnancy related claims such hospital visits, surgical procedures, and radiology exposure were related to an increased risk of ASD regardless of trimester. Urinary tract infections during the first trimester and preterm delivery during the second trimester were also related to an increased risk of ASD. Preventative and obstetrical care were associated with a decreased risk for ASD. A better understanding of the medical factors that increase the risk of having a child with ASD can lead to strategies to decrease risk or identify those children who require increased surveillance for the development of ASD to promote early diagnosis and intervention.
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Affiliation(s)
- Genevieve Grivas
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, NY 12180, USA;
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, NY 12180, USA
- OptumLabs Visiting Fellow, OptumLabs, Eden Prairie, MN 55344, USA
| | - Richard Frye
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ 85004, USA;
- Phoenix Children’s Hospital, Phoenix, AZ 85016, USA
| | - Juergen Hahn
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, New York, NY 12180, USA;
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, New York, NY 12180, USA
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, New York, NY 12180, USA
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6
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Dinkler L, Taylor MJ, Råstam M, Hadjikhani N, Bulik CM, Lichtenstein P, Gillberg C, Lundström S. Anorexia nervosa and autism: a prospective twin cohort study. J Child Psychol Psychiatry 2021; 62:316-326. [PMID: 32496594 DOI: 10.1111/jcpp.13265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. METHODS In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). RESULTS We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. CONCLUSIONS Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.
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Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Yaylaci F, Sahbudak B, Citli S, Kilit N. ASD with the Bor Syndrome: A Case Report. PSYCHOPHARMACOLOGY BULLETIN 2020; 50:45-50. [PMID: 32508366 PMCID: PMC7255838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Ferhat Yaylaci
- Yaylaci, Gaziosmanpasa University, Child and Adolescent Psychiatry Department, Tokat, Turkey. Sahbudak, Katip Celebi University, Ataturk Research and Training Hospital Child and Adolescent Psychiatry Department, Izmir, Turkey. Citli, Gaziosmanpasa University Medical Genetics Department, Tokat, Turkey. Kilit, Dr. Cevdet Aykan Mental Health Hospital, Child and Adolescent Psychiatry Department, Tokat, Turkey
| | - Begum Sahbudak
- Yaylaci, Gaziosmanpasa University, Child and Adolescent Psychiatry Department, Tokat, Turkey. Sahbudak, Katip Celebi University, Ataturk Research and Training Hospital Child and Adolescent Psychiatry Department, Izmir, Turkey. Citli, Gaziosmanpasa University Medical Genetics Department, Tokat, Turkey. Kilit, Dr. Cevdet Aykan Mental Health Hospital, Child and Adolescent Psychiatry Department, Tokat, Turkey
| | - Senol Citli
- Yaylaci, Gaziosmanpasa University, Child and Adolescent Psychiatry Department, Tokat, Turkey. Sahbudak, Katip Celebi University, Ataturk Research and Training Hospital Child and Adolescent Psychiatry Department, Izmir, Turkey. Citli, Gaziosmanpasa University Medical Genetics Department, Tokat, Turkey. Kilit, Dr. Cevdet Aykan Mental Health Hospital, Child and Adolescent Psychiatry Department, Tokat, Turkey
| | - Neriman Kilit
- Yaylaci, Gaziosmanpasa University, Child and Adolescent Psychiatry Department, Tokat, Turkey. Sahbudak, Katip Celebi University, Ataturk Research and Training Hospital Child and Adolescent Psychiatry Department, Izmir, Turkey. Citli, Gaziosmanpasa University Medical Genetics Department, Tokat, Turkey. Kilit, Dr. Cevdet Aykan Mental Health Hospital, Child and Adolescent Psychiatry Department, Tokat, Turkey
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Lundström S, Mårland C, Kuja-Halkola R, Anckarsäter H, Lichtenstein P, Gillberg C, Nilsson T. Assessing autism in females: The importance of a sex-specific comparison. Psychiatry Res 2019; 282:112566. [PMID: 31558402 DOI: 10.1016/j.psychres.2019.112566] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/12/2019] [Accepted: 09/12/2019] [Indexed: 12/16/2022]
Abstract
Autism spectrum disorder (ASD) is diagnosed more often in boys than girls. Here, we compared the degree of autism - and related disorders - symptomatology in boys and girls with a registered diagnosis of ASD. We used parent telephone interview A-TAC (Autism-Tics, ADHD and other Comorbidities) ratings of 30,392 twins aged 9 or 12 (including 308 boys and 122 girls with National Patient Register diagnoses of ASD) participating in the Child and Adolescent Twin Study in Sweden. We used z-scores for ASD-symptoms, standardized separately for boys and girls. Boys with a diagnosis of ASD had a higher raw mean score than girls with a diagnosis on the A-TAC ASD domain. However, utilizing the z-scores, girls with a diagnosis of ASD deviated further away from the female population mean than did the boys with ASD from the male population mean. Girls also had higher standardized mean values for symptoms of Attention-Deficit/Hyperactivity Disorder, Learning Disabilities and Oppositional Defiant Disorder. The findings suggest that girls diagnosed with autism may represent an even more extreme end of the female population autistic features distribution, than diagnosed boys from the male population autistic features distribution. Future studies may benefit from examining the use of sex-specific cut-off scores.
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Affiliation(s)
- Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Caroline Mårland
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Anckarsäter
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Thomas Nilsson
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Mårland C, Lubke G, Degl’Innocenti A, Råstam M, Gillberg C, Nilsson T, Lundström S. The development of a brief screener for autism using item response theory. BMC Psychiatry 2019; 19:337. [PMID: 31684913 PMCID: PMC6829932 DOI: 10.1186/s12888-019-2333-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 10/21/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Brief screening instruments focusing on autism spectrum disorder (ASD) that can be administered in primary care are scarce; there is a need for shorter and more precise instruments. The Autism-Tics, AD/HD and other Comorbidities inventory (A-TAC) has previously been validated for ASD reporting excellent validity. This study aims to determine the psychometric properties of each item in the ASD domain (17 items) in the A-TAC using item response theory (IRT), and thereby construct and validate a short form that could be used as a screening instrument in the general population. METHODS Since 2004, parents of all 9-year-old Swedish twins have been invited to participate in a telephone interview in the Child and Adolescent Twin Study in Sweden (CATSS). The CATSS is linked to the National Patient Register (NPR), which includes data from in- and outpatient care. Data on ASD (A-TAC) collected in CATSS were compared with diagnoses from the NPR. Diagnoses that had been made both before (previous validity) and after (predictive validity) the interviews were included. The sample was divided into a developmental sample and a validation sample. An IRT model was fitted to the developmental sample and item parameters were used to select a subset of items for the short form. The performance of the proposed short form was examined in the validation sample by the use of receiver operation characteristic curves. RESULTS Four items which were able to discriminate among individuals with more autism traits were deemed sufficient for use in the short form. The values of the area under the receiver operating characteristic curve for a clinical diagnosis of ASD was .95 (previous validity) and .72 (predictive validity). CONCLUSIONS The proposed short form with 4 out of the original 17 items from A-TAC, showed excellent previous validity while the predictive validity was fair. The validity of the short form was in agreement with previous validations of the full ASD domain. The short form can be a valuable screening instrument in primary care settings in order to identify individuals in need for further assessment and for use in epidemiological studies.
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Affiliation(s)
- Caroline Mårland
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Forensic Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gitta Lubke
- 0000 0001 2168 0066grid.131063.6Department of Psychology, University of Notre Dame, Notre Dame, USA
| | - Alessio Degl’Innocenti
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Råstam
- 0000 0001 0930 2361grid.4514.4Department of Clinical Sciences Lund, Lund University, Lund, Sweden ,0000 0000 9919 9582grid.8761.8Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, SE-411 19 Göteborg, Sweden
| | - Christopher Gillberg
- 0000 0000 9919 9582grid.8761.8Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, SE-411 19 Göteborg, Sweden
| | - Thomas Nilsson
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Centre for Ethics Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. .,Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, SE-411 19, Göteborg, Sweden.
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10
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Alabaf S, Gillberg C, Lundström S, Lichtenstein P, Kerekes N, Råstam M, Anckarsäter H. Physical health in children with neurodevelopmental disorders. J Autism Dev Disord 2019; 49:83-95. [PMID: 30043349 PMCID: PMC6331488 DOI: 10.1007/s10803-018-3697-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
With increasing numbers of children being diagnosed with neurodevelopmental disorders (NDDs) attention has been drawn to these children's physical health. We aimed to identify the prevalence of defined physical problems (epilepsy, migraine, asthma, cancer, diabetes, psoriasis, lactose intolerance, celiac disease, diarrhea, constipation, daytime enuresis, encopresis) in a nationwide population of 9- and 12-year-old twins subdivided into those with and without indications of NDDs. Parents of 28,058 twins participated in a well-validated telephone interview regarding their children's mental health and answered questions about their physical problems. The results indicate a high rate of physical problems in children with NDDs, particularly in those with indications of the presence of combinations of several NDDs.
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Affiliation(s)
- Setareh Alabaf
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Center for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Nóra Kerekes
- Department of Health Sciences, University West, Trollhättan, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Henrik Anckarsäter
- Center for Ethics, Law and Mental health (CELAM), Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Arvidsson O, Gillberg C, Lichtenstein P, Lundström S. Secular changes in the symptom level of clinically diagnosed autism. J Child Psychol Psychiatry 2018; 59:744-751. [PMID: 29377119 DOI: 10.1111/jcpp.12864] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The prevalence of autism has been reported to have increased worldwide. A decrease over time in the number of autism symptoms required for a clinical autism diagnosis would partly help explain this increase. This study aimed to determine whether the symptom level of clinically diagnosed autism cases below age 13 had changed over time. METHODS Parents of Swedish 9-year old twins (n = 28,118) participated in a telephone survey, in which symptoms and dysfunction/suffering related to neurodevelopmental disorders [including autism, but also attention-deficit/hyperactivity disorder (ADHD), Developmental Coordination Disorder (DCD), and Learning Disabilities (LD)] in their children were assessed over a 10-year period. Survey data was merged with the National Patient Register containing clinically registered autism diagnoses (n = 271). RESULTS In individuals who had been clinically diagnosed with autism before the age of 13, the symptom score for autism decreased on average 30% over more than a decade in birth cohorts 1992-2002. There was an average decrease of 50% in the autism symptom score from 2004 to 2014 in individuals who were diagnosed with autism at ages 7-12, but there was no decrease in those diagnosed at ages 0-6. CONCLUSIONS Over time, considerably fewer autism symptoms seemed to be required for a clinical diagnosis of autism, at least for those diagnosed after the preschool years. The findings add support for the notion that the observed increase in autism diagnoses is, at least partly, the by-product of changes in clinical practice, and flag up the need for working in agreement with best practice guidelines.
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Affiliation(s)
- Olof Arvidsson
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | | | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden.,Centre for Ethics, Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
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Yip BHK, Bai D, Mahjani B, Klei L, Pawitan Y, Hultman CM, Grice DE, Roeder K, Buxbaum JD, Devlin B, Reichenberg A, Sandin S. Heritable Variation, With Little or No Maternal Effect, Accounts for Recurrence Risk to Autism Spectrum Disorder in Sweden. Biol Psychiatry 2018; 83:589-597. [PMID: 29100626 PMCID: PMC5880679 DOI: 10.1016/j.biopsych.2017.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autism spectrum disorder (ASD) has both genetic and environmental origins, including potentially maternal effects. Maternal effects describe the association of one or more maternal phenotypes with liability to ASD in progeny that are independent of maternally transmitted risk alleles. While maternal effects could play an important role, consistent with association to maternal traits such as immune status, no study has estimated maternal, additive genetic, and environmental effects in ASD. METHODS Using a population-based sample consisting of all children born in Sweden from 1998 to 2007 and their relatives, we fitted statistical models to family data to estimate the variance in ASD liability originating from maternal, additive genetic, and shared environmental effects. We calculated sibling and cousin family recurrence risk ratio as a direct measure of familial, genetic, and environmental risk factors and repeated the calculations on diagnostic subgroups, specifically autistic disorder (AD) and spectrum disorder (SD), which included Asperger's syndrome and/or pervasive developmental disorder not otherwise specified. RESULTS The sample consisted of 776,212 children of whom 11,231 had a diagnosis of ASD: 4554 with AD, 6677 with SD. We found support for large additive genetic contribution to liability; heritability (95% confidence interval [CI]) was estimated to 84.8% (95% CI: 73.1-87.3) for ASD, 79.6% (95% CI: 61.2-85.1) for AD, and 76.4% (95% CI: 63.0-82.5) for SD. CONCLUSIONS There was modest, if any, contribution of maternal effects to liability for ASD, including subtypes AD and SD, and there was no support for shared environmental effects. These results show liability to ASD arises largely from additive genetic variation.
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Affiliation(s)
- Benjamin Hon Kei Yip
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China.
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Churbanov A, Abrahamyan L. Preventing Common Hereditary Disorders through Time-Separated Twinning. BIONANOSCIENCE 2018. [DOI: 10.1007/s12668-017-0488-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mårland C, Lichtenstein P, Degl’Innocenti A, Larson T, Råstam M, Anckarsäter H, Gillberg C, Nilsson T, Lundström S. The Autism-Tics, ADHD and other Comorbidities inventory (A-TAC): previous and predictive validity. BMC Psychiatry 2017; 17:403. [PMID: 29246205 PMCID: PMC5732476 DOI: 10.1186/s12888-017-1563-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 11/30/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reliable and easy to administer screening instruments focusing on neurodevelopmental disorders and associated conditions are scarce. The Autism-Tics, AD/HD and other Comorbidities inventory (A-TAC) has previously been validated and reporting good- excellent validity for several disorders. This article aims to expand these findings by including more conditions in a substantially larger sample augmented with the Swedish National Patient Register (NPR). METHODS Since 2004 parents of all 9-year-old Swedish twins have been invited to participate in a telephone interview in the Child and Adolescent Twin Study in Sweden, CATSS. The CATSS is linked to the NPR which includes data from in- and outpatient care. Data on neurodevelopmental disorders (A-TAC) collected in CATSS were compared with diagnoses from the NPR. We investigated diagnoses that had been made both before (previous validity) and after (predictive validity) the interview. RESULTS Sensitivity and specificity of A-TAC scores for predicting earlier or later clinical diagnoses were mostly good-excellent, with values of the area under the curve for a clinical diagnosis of autism spectrum disorder (ASD) of .98, attention deficit hyperactivity disorder (ADHD) .93, learning disorder (LD) .92, and oppositional defiant disorder (ODD) .99, with small differences in terms of previous and predictive analyses. A-TAC provided little validity for eating disorders. CONCLUSION The result support previous claims: A-TAC is a broad screening instrument with a particular strength in assessing ASD, ADHD, LD, and ODD at ages 9 and 12, and also provides phenotypic information about other child psychiatric disorders.
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Affiliation(s)
- Caroline Mårland
- Centre for Ethics Law and Mental Health (CELAM) Institute of Neuroscience and Physiology, University of Gothenburg, SU Rättspsykiatri, Rågårdsvägen 5, Enhet CELAM Hus 1, SE-424 57 Gunnilse, Gothenburg, Sweden. .,Department of Forensic Psychiatry, Sahlgrenska University Hospital, SU Rättspsykiatri, Rågårdsvägen 5, SE-424 57 Gunnilse, Gothenburg, Sweden.
| | - Paul Lichtenstein
- 0000 0004 1937 0626grid.4714.6Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77 Stockholm, Sweden
| | - Alessio Degl’Innocenti
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM) Institute of Neuroscience and Physiology, University of Gothenburg, SU Rättspsykiatri, Rågårdsvägen 5, Enhet CELAM Hus 1, SE-424 57 Gunnilse Gothenburg, Sweden ,000000009445082Xgrid.1649.aDepartment of Forensic Psychiatry, Sahlgrenska University Hospital, SU Rättspsykiatri, Rågårdsvägen 5, SE-424 57 Gunnilse Gothenburg, Sweden
| | - Tomas Larson
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM) Institute of Neuroscience and Physiology, University of Gothenburg, SU Rättspsykiatri, Rågårdsvägen 5, Enhet CELAM Hus 1, SE-424 57 Gunnilse Gothenburg, Sweden
| | - Maria Råstam
- 0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Lund University, Box 117, SE-221 00 Lund, Sweden
| | - Henrik Anckarsäter
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM) Institute of Neuroscience and Physiology, University of Gothenburg, SU Rättspsykiatri, Rågårdsvägen 5, Enhet CELAM Hus 1, SE-424 57 Gunnilse Gothenburg, Sweden
| | - Christopher Gillberg
- 0000 0000 9919 9582grid.8761.8Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE-411 19 Göteborg, Sweden
| | - Thomas Nilsson
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM) Institute of Neuroscience and Physiology, University of Gothenburg, SU Rättspsykiatri, Rågårdsvägen 5, Enhet CELAM Hus 1, SE-424 57 Gunnilse Gothenburg, Sweden
| | - Sebastian Lundström
- 0000 0000 9919 9582grid.8761.8Centre for Ethics Law and Mental Health (CELAM) Institute of Neuroscience and Physiology, University of Gothenburg, SU Rättspsykiatri, Rågårdsvägen 5, Enhet CELAM Hus 1, SE-424 57 Gunnilse Gothenburg, Sweden ,0000 0000 9919 9582grid.8761.8Gillberg Neuropsychiatry Centre Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE-411 19 Göteborg, Sweden
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Sivanesan S, Tan A, Jeyaraj R, Lam J, Gole M, Hardan A, Ashkan K, Rajadas J. Pharmaceuticals and Stem Cells in Autism Spectrum Disorders: Wishful Thinking? World Neurosurg 2017; 98:659-672. [DOI: 10.1016/j.wneu.2016.09.100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022]
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Medical history of discordant twins and environmental etiologies of autism. Transl Psychiatry 2017; 7:e1014. [PMID: 28140403 PMCID: PMC5299390 DOI: 10.1038/tp.2016.269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 11/13/2016] [Indexed: 12/27/2022] Open
Abstract
The environmental contributions to autism spectrum disorder (ASD) and their informative content for diagnosing the condition are still largely unknown. The objective of this study was to investigate associations between early medical events and ASD, as well as autistic traits, in twins, to test the hypothesis of a cumulative environmental effect on ASD risk. A total of 80 monozygotic (MZ) twin pairs (including a rare sample of 13 twin pairs discordant for clinical ASD) and 46 dizygotic (DZ) twin pairs with varying autistic traits, were examined for intra-pair differences in early medical events (for example, obstetric and neonatal factors, first year infections). First, differences in early medical events were investigated using multisource medical records in pairs qualitatively discordant for ASD. The significant intra-pair differences identified were then tested in relation to autistic traits in the remaining sample of 100 pairs, applying generalized estimating equations analyses. Significant association of the intra-pair differences in the MZ pairs were found for the cumulative load of early medical events and clinical ASD (Z=-2.85, P=0.004) and autistic traits (β=78.18, P=0.002), as well as infant dysregulation (feeding, sleeping abnormalities, excessive crying and worriedness), when controlling for intelligence quotient and attention deficit hyperactivity disorder comorbidity. The cumulative load of early medical events in general, and infant dysregulation in particular, may index children at risk of ASD owing to non-shared environmental contributions. In clinical practice, these findings may facilitate screening and early detection of ASD.
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Wang H, Liang S, Wang M, Gao J, Sun C, Wang J, Xia W, Wu S, Sumner SJ, Zhang F, Sun C, Wu L. Potential serum biomarkers from a metabolomics study of autism. J Psychiatry Neurosci 2016; 41:27-37. [PMID: 26395811 PMCID: PMC4688025 DOI: 10.1503/jpn.140009] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Early detection and diagnosis are very important for autism. Current diagnosis of autism relies mainly on some observational questionnaires and interview tools that may involve a great variability. We performed a metabolomics analysis of serum to identify potential biomarkers for the early diagnosis and clinical evaluation of autism. METHODS We analyzed a discovery cohort of patients with autism and participants without autism in the Chinese Han population using ultra-performance liquid chromatography quadrupole time-of-flight tandem mass spectrometry (UPLC/Q-TOF MS/MS) to detect metabolic changes in serum associated with autism. The potential metabolite candidates for biomarkers were individually validated in an additional independent cohort of cases and controls. We built a multiple logistic regression model to evaluate the validated biomarkers. RESULTS We included 73 patients and 63 controls in the discovery cohort and 100 cases and 100 controls in the validation cohort. Metabolomic analysis of serum in the discovery stage identified 17 metabolites, 11 of which were validated in an independent cohort. A multiple logistic regression model built on the 11 validated metabolites fit well in both cohorts. The model consistently showed that autism was associated with 2 particular metabolites: sphingosine 1-phosphate and docosahexaenoic acid. LIMITATIONS While autism is diagnosed predominantly in boys, we were unable to perform the analysis by sex owing to difficulty recruiting enough female patients. Other limitations include the need to perform test-retest assessment within the same individual and the relatively small sample size. CONCLUSION Two metabolites have potential as biomarkers for the clinical diagnosis and evaluation of autism.
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Affiliation(s)
- Han Wang
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Shuang Liang
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Maoqing Wang
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Jingquan Gao
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Caihong Sun
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Jia Wang
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Wei Xia
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Shiying Wu
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Susan J Sumner
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Fengyu Zhang
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Changhao Sun
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
| | - Lijie Wu
- From the Department of Child and Adolescent Health, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Liang, Gao, Sun, Wang, Xia, Wu); the Center for Endemic Disease Control, China Center for Disease Control and Prevention and Harbin Medical University, Harbin, Heilongjiang, China (Wang); the Department of Nutrition and Food Hygiene, School of Public Health, Harbin Medical University, Harbin, Heilongjiang, China (Wang, Sun); the Department of Nursing, Daqing Campus, Harbin Medical University, Daqing, Heilongjiang, China (Gao); the Advanced Analytic Division, SAS Institute, Inc, Cary, North Carolina, USA (Wu); Systems and Translational Sciences, Research Triangle Institute, Research Triangle Park, North Carolina, USA (Sumner); and Lieber Institute for Brain Development, Johns Hopkins University Medical Campus, Baltimore, Maryland, USA (Zhang)
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Zerbo O, Yoshida C, Gunderson EP, Dorward K, Croen LA. Interpregnancy Interval and Risk of Autism Spectrum Disorders. Pediatrics 2015; 136:651-7. [PMID: 26371204 PMCID: PMC4586728 DOI: 10.1542/peds.2015-1099] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To determine whether subsequent births after short and long interpregnancy intervals (IPIs) are associated with risk of autism spectrum disorder (ASD). METHOD We assessed the association between IPI and ASD risk in a cohort of 45 261 children born at Kaiser Permanente Northern California (KPNC) between 2000 and 2009. Children with ASD were identified from International Classification of Diseases, Revision 9 diagnostic codes 299.0, 299.8, and 299.9 recorded in KPNC electronic medical records. IPI was defined as the time from the birth of the first child to the conception of the second child. Survival analysis and logistic regression models were used to evaluate the association between IPI and risk of ASD in second-born children. RESULTS Children born after an IPI of <12 months or ≥72 months had a 2- to 3-fold increased ASD risk compared with children born after an interval of 36 to 47 months. Respective adjusted hazard ratios (95% confidence intervals) were as follows: <6 months, 3.0 (1.9-4.7); 6 to 8 months, 2.1 (1.4-3.3); 9 to 11 months, 1.9 (1.3-2.1); 12 to 23 months, 1.5 (1.1-2.1); and ≥72 months, 2.4 (1.5-3.7). The results are not explained by maternal BMI or change in BMI between pregnancies or by parental age, maternal antidepressant medication use, or unfavorable events occurring during the first or second pregnancy. CONCLUSIONS Children born after interpregnancy intervals <2 years or >6 years may be at increased risk of ASD. The mechanism explaining this association is unknown, and more research is needed.
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Affiliation(s)
- Ousseny Zerbo
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | - Cathleen Yoshida
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | - Erica P. Gunderson
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
| | - Kaht Dorward
- Department of Obstetrics and Gynecology, Kaiser Permanente Northern California, San Francisco, California
| | - Lisa A. Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, California; and
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Lundström S, Reichenberg A, Anckarsäter H, Lichtenstein P, Gillberg C. Autism phenotype versus registered diagnosis in Swedish children: prevalence trends over 10 years in general population samples. BMJ 2015; 350:h1961. [PMID: 25922345 PMCID: PMC4413835 DOI: 10.1136/bmj.h1961] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To compare the annual prevalence of the autism symptom phenotype and of registered diagnoses for autism spectrum disorder during a 10 year period in children. DESIGN Population based study. SETTING Child and Adolescent Twin Study and national patient register, Sweden. PARTICIPANTS 19, 993 twins (190 with autism spectrum disorder) and all children (n=1,078,975; 4620 with autism spectrum disorder) born in Sweden over a 10 year period from 1993 to 2002. MAIN OUTCOME MEASURES Annual prevalence of the autism symptom phenotype (that is, symptoms on which the diagnostic criteria are based) assessed by a validated parental telephone interview (the Autism-Tics, ADHD and other Comorbidities inventory), and annual prevalence of reported diagnoses of autism spectrum disorder in the national patient register. RESULTS The annual prevalence of the autism symptom phenotype was stable during the 10 year period (P=0.87 for linear time trend). In contrast, there was a monotonic significant increase in prevalence of registered diagnoses of autism spectrum disorder in the national patient register (P<0.001 for linear trend). CONCLUSIONS The prevalence of the autism symptom phenotype has remained stable in children in Sweden while the official prevalence for registered, clinically diagnosed, autism spectrum disorder has increased substantially. This suggests that administrative changes, affecting the registered prevalence, rather than secular factors affecting the pathogenesis, are important for the increase in reported prevalence of autism spectrum disorder.
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Affiliation(s)
- Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, 411 19, Gothenburg, Sweden Centre for Ethics, Law and Mental Health, University of Gothenburg, Sweden
| | - Abraham Reichenberg
- Departments of Psychiatry and Preventive Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | - Henrik Anckarsäter
- Centre for Ethics, Law and Mental Health, University of Gothenburg, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Kungsgatan 12, 411 19, Gothenburg, Sweden
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Genetic and environmental influences underlying the relationship between autistic traits and temperament and character dimensions in adulthood. Compr Psychiatry 2015; 58:178-88. [PMID: 25600422 DOI: 10.1016/j.comppsych.2014.12.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND In recent years, several twin studies adopted a dimensional approach to Autism Spectrum Disorders (ASD) and estimated the contribution of genetic and environmental influences to variation in autistic traits. However, no study was performed on adults over 18 years of age and all but two studies were based on parent or teacher ratings. Also, the genetic and environmental contributions to the interplay between autistic traits and adult personality dimensions have not been investigated. METHODS A sample of 266 complete twin pairs (30% males, mean age 40 ± 12 years) drawn from the population-based Italian Twin Register was administered the Autism-Spectrum Quotient, Temperament and Character Inventory (TCI-125), and General Health Questionnaire (GHQ-12). Genetic structural equation modelling was performed with the Mx program. Estimates were adjusted for gender, age, and GHQ-12 score. RESULTS Genetic factors accounted for 44% and 20%-49% of individual differences in autistic traits and TCI dimensions, respectively. Unshared environmental factors explained the remaining proportion of variance. Consistently with the notion of a personality profile in ASD characterised by obsessive temperament, autistic traits showed significant phenotypic correlations with several TCI dimensions (positive: HA; negative: NS, RD, SD, C). Genetic and unshared environmental correlations between AQ and these TCI dimensions were significant. The degree of genetic overlap was generally greater than the degree of environmental overlap. CONCLUSIONS Despite some limitations, this study suggests that genetic factors contribute substantially to individual differences in autistic traits in adults, with unshared environmental influences also playing an important role. It also suggests that autistic traits and the majority of temperament and character dimensions share common genetic and environmental aetiological factors.
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Common genetic variants on 1p13.2 associate with risk of autism. Mol Psychiatry 2014; 19:1212-9. [PMID: 24189344 DOI: 10.1038/mp.2013.146] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 08/25/2013] [Accepted: 09/17/2013] [Indexed: 11/08/2022]
Abstract
Autism is a highly heritable neurodevelopmental disorder, and known genetic variants, mostly rare, account only for a small proportion of cases. Here we report a genome-wide association study on autism using two Chinese cohorts as gene discovery (n=2150) and three data sets of European ancestry populations for replication analysis of top association signals. Meta-analysis identified three single-nucleotide polymorphisms, rs936938 (P=4.49 × 10(-8)), non-synonymous rs6537835 (P=3.26 × 10(-8)) and rs1877455 (P=8.70 × 10(-8)), and related haplotypes, AMPD1-NRAS-CSDE1, TRIM33 and TRIM33-BCAS2, associated with autism; all were mapped to a previously reported linkage region (1p13.2) with autism. These genetic associations were further supported by a cis-acting regulatory effect on the gene expressions of CSDE1, NRAS and TRIM33 and by differential expression of CSDE1 and TRIM33 in the human prefrontal cortex of post-mortem brains between subjects with and those without autism. Our study suggests TRIM33 and NRAS-CSDE1 as candidate genes for autism, and may provide a novel insight into the etiology of autism.
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Jiang YH, Wang Y, Xiu X, Choy KW, Pursley AN, Cheung SW. Genetic diagnosis of autism spectrum disorders: the opportunity and challenge in the genomics era. Crit Rev Clin Lab Sci 2014; 51:249-62. [PMID: 24878448 PMCID: PMC5937018 DOI: 10.3109/10408363.2014.910747] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A genetic etiology for autism spectrum disorders (ASDs) was first suggested from twin studies reported in the 1970s. The identification of gene mutations in syndromic ASDs provided evidence to support a genetic cause of ASDs. More recently, genome-wide copy number variant and sequence analyses have uncovered a list of rare and highly penetrant copy number variants (CNVs) or single nucleotide variants (SNVs) associated with ASDs, which has strengthened the claim of a genetic etiology for ASDs. Findings from research studies in the genetics of ASD now support an important role for molecular diagnostics in the clinical genetics evaluation of ASDs. Various molecular diagnostic assays including single gene tests, targeted multiple gene panels and copy number analysis should all be considered in the clinical genetics evaluation of ASDs. Whole exome sequencing could also be considered in selected clinical cases. However, the challenge that remains is to determine the causal role of genetic variants identified through molecular testing. Variable expressivity, pleiotropic effects and incomplete penetrance associated with CNVs and SNVs also present significant challenges for genetic counseling and prenatal diagnosis.
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Affiliation(s)
- Yong-Hui Jiang
- Department of Pediatrics and Neurobiology, Duke University School of Medicine, Durham, NC, USA
- Division of Neurology, The Children’s Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Yi Wang
- Division of Neurology, The Children’s Hospital of Fudan University, Shanghai, People’s Republic of China
| | - Xu Xiu
- Division of Child Development and Health, The Children’s Hospital of Fudan University Shanghai, People’s Republic of China
| | - Kwong Wai Choy
- Department of Obstetrics and Gynecology, and Joint Centre with Utrecht University Genetic core, School of Biomedical Sciences, The Chinese University of Hong Kong, Hong Kong, People’s Republic of China
| | - Amber Nolen Pursley
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
| | - Sau W. Cheung
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, USA
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Abstract
Neurodevelopmental disorders affect a substantial minority of the general population. Their origins are still largely unknown, but a complex interplay of genetic and environmental factors causing disturbances of the central nervous system's maturation and a variety of higher cognitive skills is presumed. Only limited research of rather small sample size and narrow scope has been conducted in neurodevelopmental disorders using a twin-differences design. The Roots of Autism and ADHD Twin Study in Sweden (RATSS) is an ongoing project targeting monozygotic twins discordant for categorical or dimensional autistic and inattentive/hyperactive-impulsive phenotypes as well as other neurodevelopmental disorders, and typically developing twin controls. Included pairs are 9 years of age or older, and comprehensively assessed for psychopathology, medical history, neuropsychology, and dysmorphology, as well as structural, functional, and molecular brain imaging. Specimens are collected for induced pluripotent (iPS) and neuroepithelial stem cells, genetic, gut bacteria, protein-/monoamine, and electron microscopy analyses. RATSS's objective is to generate a launch pad for novel surveys to understand the complexity of genotype-environment-phenotype interactions in autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD). By October 2013, RATSS had collected data from 55 twin pairs, among them 10 monozygotic pairs discordant for autism spectrum disorder, seven for ADHD, and four for other neurodevelopmental disorders. This article describes the design, recruitment, data collection, measures, collected pairs' characteristics, as well as ongoing and planned analyses in RATSS. Potential gains of the study comprise the identification of environmentally mediated biomarkers, the emergence of candidates for drug development, translational modeling, and new leads for prevention of incapacitating outcomes.
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Petrinovic MM, Künnecke B. Neuroimaging endophenotypes in animal models of autism spectrum disorders: lost or found in translation? Psychopharmacology (Berl) 2014; 231:1167-89. [PMID: 23852013 DOI: 10.1007/s00213-013-3200-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/26/2013] [Indexed: 11/26/2022]
Abstract
RATIONALE Autism spectrum disorder(s) (ASDs) is a neurodevelopmental disorder characterized by stereotyped behaviours and impairments in communication and social interactions. This heterogeneity has been a major obstacle in uncovering the aetiology and biomarkers of ASDs. Rodent models with genetic modifications or environmental insults have been created to study particular endophenotypes and bridge the gap between genetics and behavioural phenotypes. Translational neuroimaging modalities with their ability to screen the brain noninvasively and yield structural, biochemical and functional information provide a unique platform for discovery and evaluation of such endophenotypes in preclinical and clinical research. OBJECTIVES We reviewed literature on translational neuroimaging in rodent models of ASDs. The most prominent models will be described and the respective neuroimaging endophenotypes will be discussed with reference to human data. A perspective on future directions of translational neuroimaging in animal models of ASDs will be given. RESULTS AND CONCLUSIONS To date, we experience a proliferation of rodent models which recapitulate specific liabilities identified in ASDs patients. Translational neuroimaging in these models is emerging but is skewed towards magnetic resonance imaging (MRI) modalities. Volumetric and structural assessments of the brain are dominating and a host of endophenotypes have been reported that allude to findings in ASDs patients but with only few to converge among the models. Caveats of current studies are the diverging biological conditions related to genetic background and age of the animals. It is anticipated that longitudinal and functional assessments will gain much importance and will help elucidating mechanistic relationship between behavioural and structural endophenotypes.
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Affiliation(s)
- Marija M Petrinovic
- F. Hoffmann-La Roche AG, pRED, Pharma Research and Early Development, DTA Neuroscience, Building 68, Room 327A, Grenzacherstrasse 124, 4070, Basel, Switzerland
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Moldrich RX, Leanage G, She D, Dolan-Evans E, Nelson M, Reza N, Reutens DC. Inhibition of histone deacetylase in utero causes sociability deficits in postnatal mice. Behav Brain Res 2013; 257:253-64. [DOI: 10.1016/j.bbr.2013.09.049] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 09/23/2013] [Accepted: 09/27/2013] [Indexed: 01/08/2023]
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Hu VW. From genes to environment: using integrative genomics to build a "systems-level" understanding of autism spectrum disorders. Child Dev 2012; 84:89-103. [PMID: 22497667 DOI: 10.1111/j.1467-8624.2012.01759.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Autism spectrum disorders (ASD) are pervasive neurodevelopmental disorders that affect an estimated 1 in 110 individuals. Although there is a strong genetic component associated with these disorders, this review focuses on the multifactorial nature of ASD and how different genome-wide (genomic) approaches contribute to our understanding of autism. Emphasis is placed on the need to study defined ASD phenotypes as well as to integrate large-scale "omics" data in order to develop a "systems-level" perspective of ASD, which in turn is necessary to allow predictions regarding responses to specific perturbations and interventions.
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Affiliation(s)
- Valerie W Hu
- The George Washington University, School of Medicine and Health Sciences.
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28
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Fairless AH, Dow HC, Kreibich AS, Torre M, Kuruvilla M, Gordon E, Morton EA, Tan J, Berrettini WH, Li H, Abel T, Brodkin ES. Sociability and brain development in BALB/cJ and C57BL/6J mice. Behav Brain Res 2011; 228:299-310. [PMID: 22178318 DOI: 10.1016/j.bbr.2011.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2011] [Revised: 11/30/2011] [Accepted: 12/01/2011] [Indexed: 12/22/2022]
Abstract
Sociability--the tendency to seek social interaction--propels the development of social cognition and social skills, but is disrupted in autism spectrum disorders (ASD). BALB/cJ and C57BL/6J inbred mouse strains are useful models of low and high levels of juvenile sociability, respectively, but the neurobiological and developmental factors that account for the strains' contrasting sociability levels are largely unknown. We hypothesized that BALB/cJ mice would show increasing sociability with age but that C57BL/6J mice would show high sociability throughout development. We also hypothesized that littermates would resemble one another in sociability more than non-littermates. Finally, we hypothesized that low sociability would be associated with low corpus callosum size and increased brain size in BALB/cJ mice. Separate cohorts of C57BL/6J and BALB/cJ mice were tested for sociability at 19-, 23-, 31-, 42-, or 70-days-of-age, and brain weights and mid-sagittal corpus callosum area were measured. BALB/cJ sociability increased with age, and a strain by age interaction in sociability between 31 and 42 days of age suggested strong effects of puberty on sociability development. Sociability scores clustered according to litter membership in both strains, and perinatal litter size and sex ratio were identified as factors that contributed to this clustering in C57BL/6J, but not BALB/cJ, litters. There was no association between corpus callosum size and sociability, but smaller brains were associated with lower sociability in BALB/cJ mice. The associations reported here will provide directions for future mechanistic studies of sociability development.
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Affiliation(s)
- Andrew H Fairless
- Center for Neurobiology and Behavior, Department of Psychiatry, University of Pennsylvania School of Medicine, Translational Research Laboratory, 125 South 31st Street, Philadelphia, PA 19104-3403, USA
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Schieve LA, Rice C, Devine O, Maenner MJ, Lee LC, Fitzgerald R, Wingate MS, Schendel D, Pettygrove S, van Naarden Braun K, Durkin M. Have secular changes in perinatal risk factors contributed to the recent autism prevalence increase? Development and application of a mathematical assessment model. Ann Epidemiol 2011; 21:930-45. [PMID: 22000328 DOI: 10.1016/j.annepidem.2011.08.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Revised: 08/30/2011] [Accepted: 08/31/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND A 57% increase in the U.S. prevalence of autism spectrum disorders (ASD) for 8-year-old children born in 1994 versus 1998 was recently reported. METHODS To quantify the possible contributions of given risk/predictive factors on the recent ASD prevalence increase, we formulated a mathematical model based on the baseline risk factor prevalence (RFP), the proportionate change in RFP (cRFP), and the magnitude of the association between the risk factor and ASD [estimated relative risk (RR)]. We applied this model to several pregnancy-related factors (preterm, very preterm, low and very low birth weight, multiple birth, cesarean delivery, breech presentation, and assisted reproductive technology use). RFP and cRFP estimates for each factor were obtained from U.S. population-based surveillance datasets. Estimated RRs were obtained from a series of systematic literature reviews. RESULTS We estimate that each risk factor examined, alone or in various combinations, accounted for a very small proportion (<1%) of the ASD increase. Additionally, hypothetical scenarios indicate RFP, cRFP, and RR all need to be sizable for a risk factor to appreciably influence ASD prevalence. CONCLUSIONS Thus, although various pregnancy factors have been found to be associated with ASDs, the contribution of many of these factors to the recently observed ASD increase is likely minimal.
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Affiliation(s)
- Laura A Schieve
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Curran S, Dworzynski K, Happé F, Ronald A, Allison C, Baron-Cohen S, Brayne C, Bolton PF. No major effect of twinning on autistic traits. Autism Res 2011; 4:377-82. [PMID: 21766464 DOI: 10.1002/aur.207] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND It has been questioned whether the process of twinning might be a risk factor for autism spectrum conditions (ASC) and autistic traits. AIM We sought to determine whether autistic traits and probable disorder, as measured by the Childhood Autism Spectrum Test (CAST), were more pronounced in twins compared to singletons. SAMPLES Data were analyzed from two large population-based samples of UK children, twins (n = 5,142 twin pairs, aged 8 years) and singletons (n = 2,805, aged 5-9 years). RESULTS Distributions of CAST scores in both groups were negatively skewed and scores for twins were more variable than singletons. Mean CAST total scores and standard errors (SE) were not significantly different for twins (5.1; SE 0.04) compared to singletons (4.9; SE 0.08). Moreover, contrary to expectations, the likelihood of scoring above the threshold for possible ASC was significantly lower in the twins than the singletons (OR = 0.69; P = 0.002). Subsidiary analyses of CAST scores according to sex, twin type, and subscale scores representing the subdomains of autism found a few significant differences (P<0.01), but the effect sizes for these differences were small and none exceeded η(2) = 0.005. The explanation for these small differences remains obscure, but the very small effect sizes mean they are of little importance. CONCLUSIONS Our results do not provide evidence to support twinning as a risk factor in the development of autistic traits.
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Affiliation(s)
- Sarah Curran
- Department of Child & Adolescent Psychiatry, Institute of Psychiatry, King's College London, United Kingdom.
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Efficiency of a Small Size Screening Instrument in Identifying Children with Autism Spectrum Disorders in a Large Population of Twins. ACTA ACUST UNITED AC 2011. [DOI: 10.1155/2011/412150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study evaluated the effectiveness of a short scale in screening for autism spectrum disorders (ASDs) and documented the prevalence of ASD in twins born in 1988–2000 as registered in the Danish Psychiatric Central Research Registry (DPCRR). Five child behaviour checklist (CBCL) items were used in a first-phase screening of all twins born 1988–2000, recruited from the Danish Twin Registry. In Denmark, nearly all psychiatric diagnoses are reported to DPCRR, and the two registers were linked for validation purposes. Parents of >16,000 twins responded (68.4%); among the twins, 108 were registered with ASD. The optimal cut-off score of two out of ten yielded a sensitivity of 79.6% and a specificity of 81.4%. The registry linkage identified 176 twins with ASD (point prevalence = 0.72%). This study demonstrates that it is feasible to screen large populations for ASD with a 5-item questionnaire. The prevalence of registered ASD in twins corresponds to recent population-based studies in singletons.
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Ronald A, Hoekstra RA. Autism spectrum disorders and autistic traits: a decade of new twin studies. Am J Med Genet B Neuropsychiatr Genet 2011; 156B:255-74. [PMID: 21438136 DOI: 10.1002/ajmg.b.31159] [Citation(s) in RCA: 357] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 11/30/2010] [Indexed: 11/11/2022]
Abstract
Researchers continue to pursue a better understanding of the symptoms, comorbidities, and causes of autism spectrum disorders. In this article we review more than 30 twin studies of autism spectrum disorders (ASDs) and autistic traits published in the last decade that have contributed to this endeavor. These twin studies have reported on the heritability of autism spectrum disorders and autistic traits in different populations and using different measurement and age groups. These studies have also stimulated debate and new hypotheses regarding why ASDs show substantial symptom heterogeneity, and what causes their comorbidity with intellectual disability, language delay, and other psychiatric disorders such as ADHD. These studies also reveal that the etiology of autism and autistic traits assessed in the general population is more similar than different, which contributes to the question of where the boundary lies between autism and typical development. Recent findings regarding molecular genetic and environmental causes of autism are discussed in the relation to these twin studies. Lastly, methodological assumptions of the twin design are given consideration, as well as issues of measurement. Future research directions are suggested to ensure that this decade is as productive as the last in attempting to disentangle the causes of autism spectrum disorders.
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Affiliation(s)
- Angelica Ronald
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, UK.
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33
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Multiple autism-like behaviors in a novel transgenic mouse model. Behav Brain Res 2010; 218:29-41. [PMID: 21093492 DOI: 10.1016/j.bbr.2010.11.026] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 11/05/2010] [Accepted: 11/09/2010] [Indexed: 11/21/2022]
Abstract
Autism spectrum disorder (ASD) diagnoses are behaviorally based with no defined universal biomarkers, occur at a 1:110 ratio in the population, and predominantly affect males compared to females at approximately a 4:1 ratio. One approach to investigate and identify causes of ASD is to use organisms that display abnormal behavioral responses that model ASD-related impairments. This study describes a novel transgenic mouse, MALTT, which was generated using a forward genetics approach. It was determined that the transgene integrated within a non-coding region on the X chromosome. The MALTT line exhibited a complete repertoire of ASD-like behavioral deficits in all three domains required for an ASD diagnosis: reciprocal social interaction, communication, and repetitive or inflexible behaviors. Specifically, MALTT male mice showed deficits in social interaction and interest, abnormalities in pup and juvenile ultrasonic vocalization communications, and exhibited a repetitive stereotypy. Abnormalities were also observed in the domain of sensory function, a secondary phenotype prevalently associated with ASD. Mapping and expression studies suggested that the Fam46 gene family may be linked to the observed ASD-related behaviors. The MALTT line provides a unique genetic model for examining the underlying biological mechanisms involved in ASD-related behaviors.
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Bishop DVM. Overlaps between autism and language impairment: phenomimicry or shared etiology? Behav Genet 2010; 40:618-29. [PMID: 20640915 PMCID: PMC2921070 DOI: 10.1007/s10519-010-9381-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/02/2010] [Indexed: 01/29/2023]
Abstract
Traditionally, autistic spectrum disorder (ASD) and specific language impairment (SLI) are regarded as distinct conditions with separate etiologies. Yet these disorders co-occur at above chance levels, suggesting shared etiology. Simulations, however, show that additive pleiotropic genes cannot account for observed rates of language impairment in relatives, which are higher for probands with SLI than for those with ASD + language impairment. An alternative account is in terms of ‘phenomimicry’, i.e., language impairment in comorbid cases may be a consequence of ASD risk factors, and different from that seen in SLI. However, this cannot explain why molecular genetic studies have found a common risk genotype for ASD and SLI. This paper explores whether nonadditive genetic influences could account for both family and molecular findings. A modified simulation involving G × G interactions obtained levels of comorbidity and rates of impairment in relatives more consistent with observed values. The simulations further suggest that the shape of distributions of phenotypic trait scores for different genotypes may provide evidence of whether a gene is involved in epistasis.
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Affiliation(s)
- D V M Bishop
- Department of Experimental Psychology, University of Oxford, Oxford OX1 3UD, UK.
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Chez MG, Guido-Estrada N. Immune therapy in autism: historical experience and future directions with immunomodulatory therapy. Neurotherapeutics 2010; 7:293-301. [PMID: 20643382 PMCID: PMC5084233 DOI: 10.1016/j.nurt.2010.05.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2010] [Revised: 05/23/2010] [Accepted: 05/26/2010] [Indexed: 12/12/2022] Open
Abstract
Autism affects 1 in 110 new births, and it has no single etiology with uniform agreement. This has a significant impact on the quality of life for individuals who have been diagnosed with autism. Although autism has a spectrum quality with a shared diagnosis, it presents a uniquely different clinical appearance in each individual. Recent research of suspected immunological factors have provided more support for a probable immunological process or for processes that may play a role in the acquisition of an autistic condition. These factors include prenatal, genetic, and postnatal findings, as well as the discovery of a dysfunctional chronic pro-inflammatory state in brain tissue and cerebrospinal fluid in subsets of autistic patients. These findings offer new theories that may lead to the development of disease modification or preventative therapeutic options in the near future. This article reviews prenatal, genetic, and observed immune aspects of the autism condition that may be risk factors in the presentation of the autistic clinical phenotype. Historical immune interventions in autism are reviewed and potential new therapies and interventions are discussed.
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Affiliation(s)
- Michael G Chez
- Pediatric Neurology and Autism Neurodevelopmental Program, Sutter Neuroscience Institute, Sacramento, California 95816, USA.
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36
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The creatine transporter gene paralogous at 16p11.2 is expressed in human brain. Comp Funct Genomics 2010:609684. [PMID: 18509488 PMCID: PMC2396218 DOI: 10.1155/2008/609684] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2008] [Revised: 03/25/2008] [Accepted: 03/27/2008] [Indexed: 11/17/2022] Open
Abstract
Autism is a complex neurodevelopmental disorder characterized by impairment of social interaction, language, communication, and stereotyped, repetitive behavior. Genetic predisposition to autism has been demonstrated in families and twin studies. About 5-10% of autism cases are associated with chromosomal abnormalities or monogenic disorders. The identification of genes involved in the origin of autism is expected to increase our understanding of the pathogenesis. We report on the clinical, cytogenetic, and molecular findings in a boy with autism carrying a de novo translocation t(7;16)(p22.1;p11.2). The chromosome 16 breakpoint disrupts the paralogous SLC6A8 gene also called SLC6A10 or CT2. Predicted translation of exons and RT-PCR analysis reveal specific expression of the creatine transporter paralogous in testis and brain. Several studies reported on the role of X-linked creatine transporter mutations in individuals with mental retardation, with or without autism. The existence of disruption in SLC6A8 paralogous gene associated with idiopathic autism suggests that this gene may be involved in the autistic phenotype in our patient.
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Abstract
Psychiatric diseases place a tremendous burden on affected individuals, their caregivers, and the health care system. Although evidence exists for a strong inherited component to many of these conditions, dedicated efforts to identify DNA sequence-based causes have not been exceptionally productive, and very few pharmacologic treatment options are clinically available. Many features of psychiatric diseases are consistent with an epigenetic dysregulation, such as discordance of monozygotic twins, late age of onset, parent-of-origin and sex effects, and fluctuating disease course. In recent years, experimental technologies have significantly advanced, permitting indepth studies of the epigenome and its role in maintenance of normal genomic functions, as well as disease etiopathogenesis. Here, we present an epigenetic explanation for many characteristics of psychiatric disease, review the current literature on the epigenetic mechanisms involved in major psychosis, Alzheimer's disease, and autism spectrum disorders, and describe some future directions in the field of psychiatric epigenomics.
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Affiliation(s)
- Carolyn Ptak
- The Krembil Family Epigenetics Laboratory, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Kolozsi E, Mackenzie R, Roullet F, Decatanzaro D, Foster J. Prenatal exposure to valproic acid leads to reduced expression of synaptic adhesion molecule neuroligin 3 in mice. Neuroscience 2009; 163:1201-10. [DOI: 10.1016/j.neuroscience.2009.07.021] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 07/04/2009] [Accepted: 07/09/2009] [Indexed: 01/25/2023]
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Hah M, Lotspeich LJ, Phillips JM, Torres AD, Cleveland SC, Hallmayer JF. Twins with KBG syndrome and autism. J Autism Dev Disord 2009; 39:1744-6. [PMID: 19597979 DOI: 10.1007/s10803-009-0811-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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40
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Hu VW, Nguyen A, Kim KS, Steinberg ME, Sarachana T, Scully MA, Soldin SJ, Luu T, Lee NH. Gene expression profiling of lymphoblasts from autistic and nonaffected sib pairs: altered pathways in neuronal development and steroid biosynthesis. PLoS One 2009; 4:e5775. [PMID: 19492049 PMCID: PMC2685981 DOI: 10.1371/journal.pone.0005775] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2009] [Accepted: 05/06/2009] [Indexed: 11/18/2022] Open
Abstract
Despite the identification of numerous autism susceptibility genes, the pathobiology of autism remains unknown. The present “case-control” study takes a global approach to understanding the molecular basis of autism spectrum disorders based upon large-scale gene expression profiling. DNA microarray analyses were conducted on lymphoblastoid cell lines from over 20 sib pairs in which one sibling had a diagnosis of autism and the other was not affected in order to identify biochemical and signaling pathways which are differentially regulated in cells from autistic and nonautistic siblings. Bioinformatics and gene ontological analyses of the data implicate genes which are involved in nervous system development, inflammation, and cytoskeletal organization, in addition to genes which may be relevant to gastrointestinal or other physiological symptoms often associated with autism. Moreover, the data further suggests that these processes may be modulated by cholesterol/steroid metabolism, especially at the level of androgenic hormones. Elevation of male hormones, in turn, has been suggested as a possible factor influencing susceptibility to autism, which affects ∼4 times as many males as females. Preliminary metabolic profiling of steroid hormones in lymphoblastoid cell lines from several pairs of siblings reveals higher levels of testosterone in the autistic sibling, which is consistent with the increased expression of two genes involved in the steroidogenesis pathway. Global gene expression profiling of cultured cells from ASD probands thus serves as a window to underlying metabolic and signaling deficits that may be relevant to the pathobiology of autism.
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Affiliation(s)
- Valerie W Hu
- Department of Biochemistry and Molecular Biology, The George Washington University Medical Center, Washington, DC, USA.
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41
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Stam AJ, Schothorst PF, Vorstman JA, Staal WG. The genetic overlap of attention deficit hyperactivity disorder and autistic spectrum disorder. APPLICATION OF CLINICAL GENETICS 2009; 2:7-13. [PMID: 23776346 PMCID: PMC3681037 DOI: 10.2147/tacg.s4683] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Autistic spectrum disorders (ASD) and attention deficit hyperactivity disorder (ADHD) are classified as distinct disorders within the DSM-IV-TR (1994). The manual excludes simultaneous use of both diagnoses in case of overlap on a symptomatic level. However this does not always represent clinical observations and findings of previous studies. This review explores the genetic basis of the phenomenological overlap between ADHD and ASD. Based on an extensive review of twin-, linkage-, association studies, and reported structural genomic abnormalities associated with these disorders, we have identified seventeen regions on the human genome that can be related to both disorders. These regions of shared genetic association are: 2q35, 3p14, 4p16.1, 4p16.3, 5p15.31, 5p15.33, 7p12.3, 7p22, 7q21, 8q24.3, 14q12, 15q11–12, 16p13, 17q11, 18q21–23, 22q11.2, Xp22.3. The presented data are of interest for future genetic studies and appear to suggest the existence of a phenotype partition that may differ from the current classification of psychiatric disorders.
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Affiliation(s)
- Arie J Stam
- University Medical Center Utrecht (UMC Utrecht), Utrecht, The Netherlands
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42
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Kakinuma H, Sato H. Copy-number variations associated with autism spectrum disorder. Pharmacogenomics 2009; 9:1143-54. [PMID: 18681787 DOI: 10.2217/14622416.9.8.1143] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Autism spectrum disorder (ASD) is a clinically heterogeneous developmental disorder with a strong genetic component. Rare genetic disorders and various chromosomal abnormalities are thought to account for approximately 10% of people with ASD. The etiology of the remaining cases remains unknown. Recent advances in array-based technology have increased the resolution in detecting submicroscopic deletions and duplications, referred to as copy-number variations. ASD-associated copy-number variations, which are considered to be present in individuals with ASD but not in unaffected individuals, have been extensively investigated. These data will provide us with an opportunity not only to search for genes causing or contributing to ASDs but also to understand the genetics of ASD.
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Affiliation(s)
- Hiroaki Kakinuma
- Department of Pediatrics, Kanazawa Medical University, 1-1 Uchinada, Kahoku-gun, Ishikawa 920-293, Japan.
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43
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Genetic correlation between autistic traits and IQ in a population-based sample of twins with autism spectrum disorders (ASDs). J Hum Genet 2009; 54:56-61. [DOI: 10.1038/jhg.2008.3] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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44
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Weissman JR, Kelley RI, Bauman ML, Cohen BH, Murray KF, Mitchell RL, Kern RL, Natowicz MR. Mitochondrial disease in autism spectrum disorder patients: a cohort analysis. PLoS One 2008; 3:e3815. [PMID: 19043581 PMCID: PMC2584230 DOI: 10.1371/journal.pone.0003815] [Citation(s) in RCA: 165] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2008] [Accepted: 11/04/2008] [Indexed: 01/22/2023] Open
Abstract
Background Previous reports indicate an association between autism spectrum disorders (ASD) and disorders of mitochondrial oxidative phosphorylation. One study suggested that children with both diagnoses are clinically indistinguishable from children with idiopathic autism. There are, however, no detailed analyses of the clinical and laboratory findings in a large cohort of these children. Therefore, we undertook a comprehensive review of patients with ASD and a mitochondrial disorder. Methodology/Principal Findings We reviewed medical records of 25 patients with a primary diagnosis of ASD by DSM-IV-TR criteria, later determined to have enzyme- or mutation-defined mitochondrial electron transport chain (ETC) dysfunction. Twenty-four of 25 patients had one or more major clinical abnormalities uncommon in idiopathic autism. Twenty-one patients had histories of significant non-neurological medical problems. Nineteen patients exhibited constitutional symptoms, especially excessive fatigability. Fifteen patients had abnormal neurological findings. Unusual developmental phenotypes included marked delay in early gross motor milestones (32%) and unusual patterns of regression (40%). Levels of blood lactate, plasma alanine, and serum ALT and/or AST were increased at least once in 76%, 36%, and 52% of patients, respectively. The most common ETC disorders were deficiencies of complex I (64%) and complex III (20%). Two patients had rare mtDNA mutations of likely pathogenicity. Conclusions/Significance Although all patients' initial diagnosis was idiopathic autism, careful clinical and biochemical assessment identified clinical findings that differentiated them from children with idiopathic autism. These and prior data suggest a disturbance of mitochondrial energy production as an underlying pathophysiological mechanism in a subset of individuals with autism.
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Affiliation(s)
- Jacqueline R. Weissman
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Richard I. Kelley
- Department of Pediatrics, Johns Hopkins University Medical Center and Division of Metabolism, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
| | - Margaret L. Bauman
- Department of Pediatrics and Learning and Developmental Disabilities Evaluation and Rehabilitation Services (LADDERS), Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Bruce H. Cohen
- Neurological Institute and Pediatrics Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Katherine F. Murray
- Department of Pediatrics and Learning and Developmental Disabilities Evaluation and Rehabilitation Services (LADDERS), Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Rebecca L. Mitchell
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Rebecca L. Kern
- Department of Pediatrics, Johns Hopkins University Medical Center and Division of Metabolism, Kennedy Krieger Institute, Baltimore, Maryland, United States of America
| | - Marvin R. Natowicz
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, United States of America
- Neurological Institute and Pediatrics Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Genomic Medicine Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
- * E-mail:
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45
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The 'fractionable autism triad': a review of evidence from behavioural, genetic, cognitive and neural research. Neuropsychol Rev 2008; 18:287-304. [PMID: 18956240 DOI: 10.1007/s11065-008-9076-8] [Citation(s) in RCA: 282] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Accepted: 09/13/2008] [Indexed: 10/21/2022]
Abstract
Autism is diagnosed on the basis of a triad of impairments in social interaction, communication, and flexible imaginative functions (with restricted and repetitive behaviors and interests; RRBIs). There has been a strong presumption that these different features of the syndrome are strongly intertwined and proceed from a common cause at the genetic, cognitive and neural levels. In this review we examine evidence for an alternative approach, considering the triad as largely 'fractionable'. We present evidence from our own twin studies, and review relevant literature on autism and autistic-like traits in other groups. We suggest that largely independent genes may operate on social skills/impairments, communication abilities, and RRBIs, requiring a change in molecular-genetic research approaches. At the cognitive level, we suggest that satisfactory accounts exist for each of the triad domains, but no single unitary account can explain both social and nonsocial features of autism. We discuss the implications of the fractionable-triad approach for both diagnosis and future research directions.
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46
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Van Naarden Braun K, Schieve L, Daniels J, Durkin M, Giarelli E, Kirby RS, Lee LC, Newschaffer C, Nicholas J, Pinto-Martin J. Relationships between multiple births and autism spectrum disorders, cerebral palsy, and intellectual disabilities: autism and developmental disabilities monitoring (ADDM) network-2002 surveillance year. Autism Res 2008; 1:266-74. [PMID: 19360679 DOI: 10.1002/aur.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Since the 1970s, the prevalence of multiple births (MBs) in the United States has increased significantly. This has been attributed, in large part, to iatrogenic MBs resulting from infertility treatments that include ovulation stimulation. A past study has indicated that children from MBs have an increased prevalence of cerebral palsy (CP). Other studies also have suggested an association between MBs and intellectual disabilities (ID) and autism spectrum disorders (ASDs); however, results have been inconsistent. From the Autism and Developmental Disabilities Monitoring (ADDM) Network, a surveillance project among several US populations, we obtained MB estimates among children born in 1994 and classified by 8 years of age as having: an ASD (n=1,626 total children from 11 sites; 50 born as part of an MB); CP (n=302 total children from 3 sites; 25 born as part of an MB); or ID (n=1,195 total children from 3 sites; 45 born as part of an MB). All three MB estimates were notably higher than age-adjusted expected estimates of naturally conceived MBs derived from 1971 US natality data. However, when MB estimates from the ADDM Network were compared with expected MB estimates derived from 1994 natality data for the states corresponding to the relevant ADDM Network sites, we observed no association with ASDs (observed/expected=1.08 [0.78-1.38]), a moderate, but not statistically significant association with ID (observed/expected=1.34 [0.95-1.73]), and a strong association with CP (observed/expected=2.96 [1.80-4.12]). Further investigation of specific types of MBs (natural vs. iatrogenic) is warranted.
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Affiliation(s)
- Kim Van Naarden Braun
- Developmental Disabilities Branch, National Centers on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road (MS E-86), Atlanta, GA 30333, USA.
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47
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Taniai H, Nishiyama T, Miyachi T, Imaeda M, Sumi S. Genetic influences on the broad spectrum of autism: study of proband-ascertained twins. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:844-9. [PMID: 18361421 DOI: 10.1002/ajmg.b.30740] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
An investigation of genetic structures underlying autistic traits was performed with samples from twins for which at least one proband had been ascertained as having autism spectrum disorders (ASDs) in our catchment area. In order to adjust for recent concepts of autism, we employed criteria for the broad spectrum of disease and the childhood autism rating scale (CARS) for quantitative assessment. The CARS test was performed on 45 twin pairs (19 monozygotic, 26 dizygotic) detected with a regional routine screening system. The obtained CARS scores were subjected to structural equation modeling (SEM), incorporating sex differences for each causal influence ascertainment correction, using the Mx software. A best fitting model of causal influences on autistic traits measured continuously, incorporating additive genetic (A) and non-shared environmental influences (E), was generated. With this AE model, the estimated heritability was 0.73 for males and 0.87 for females, based on the continuous CARS scores. There was no evidence for the existence of sex-specific genetic influences. Autistic traits were highly heritable in twins with even broad spectrum of autism, corresponding to the results of early studies based on classical autism. Additive genetic factors were more influential in females than males.
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48
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De novo balanced translocation t (7;16) (p22.1; p11.2) associated with autistic disorder. J Biomed Biotechnol 2008; 2008:231904. [PMID: 18475318 PMCID: PMC2373955 DOI: 10.1155/2008/231904] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2007] [Accepted: 01/24/2008] [Indexed: 11/18/2022] Open
Abstract
The high incidence of de novo chromosomal aberrations in a population of persons with autism suggests a causal relationship between certain chromosomal aberrations and the occurrence of isolated idiopathic autism. We report on the clinical and cytogenetic findings in a male patient with autism, no physical abnormalities and a de novo balanced (7;16)(p22.1;p16.2) translocation. G-banded chromosomes and fluorescent in situ hybridization (FISH) were used to examine the patient's karyotype as well as his parents'. FISH with specific RP11-BAC clones mapping near 7p22.1 and 16p11.2 was used to refine the location of the breakpoints. This is, in the best of our knowledge, the first report of an individual with autism and this specific chromosomal aberration.
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49
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Intersubjectivity, affective neuroscience, and the neurobiology of autistic spectrum disorders: a systematic review. Keio J Med 2008; 57:15-36. [PMID: 18382122 DOI: 10.2302/kjm.57.15] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Intersubjectivity is an approach to the study of social interaction viewed from a perspective which rejects the view that reducing any such analysis to study at the level of the individual is adequate to address the issues of social functioning. It also stresses the view that social processes cannot be reduced to cognitive ones - most of the important questions in the study of developmental psychopathology deal with issues which have commonality with many other species and are patent well before the ontological emergence of 'cognitive' abilities. In this paper we review the evidence in this area, and discuss a range of issues relevant to autistic spectrum disorders. We focus in particular on social interaction; the role of the Intrinsic Motive Formation and recent work on mirror neurons in autism; genetic and teratogenic factors in the genesis of autism; and the role of a number of biological factors in pathogenesis - tryptophan; vitamin B12; sterol metabolism; glutamate and GABA; and the Fragile-X expansion.
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50
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Roohi J, Montagna C, Tegay DH, Palmer LE, DeVincent C, Pomeroy JC, Christian SL, Nowak N, Hatchwell E. Disruption of contactin 4 in three subjects with autism spectrum disorder. J Med Genet 2008; 46:176-82. [PMID: 18349135 PMCID: PMC2643049 DOI: 10.1136/jmg.2008.057505] [Citation(s) in RCA: 123] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Autism spectrum disorder (ASD) is a developmental disorder of the central nervous system of largely unknown aetiology. The prevalence of the syndrome underscores the need for biological markers and a clearer understanding of pathogenesis. For these reasons, a genetic study of idiopathic ASD was undertaken. Methods and results: Array based comparative genomic hybridisation identified a paternally inherited chromosome 3 copy number variation (CNV) in three subjects: a deletion in two siblings and a duplication in a third, unrelated individual. These variations were fluorescence in situ hybridisation (FISH) validated and the end points further delineated using a custom fine tiling oligonucleotide array. Polymerase chain reaction (PCR) products unique to the rearrangements were amplified and sequence analysis revealed the variations to have resulted from Alu Y mediated unequal recombinations interrupting contactin 4 (CNTN4). Conclusion: CNTN4 plays an essential role in the formation, maintenance, and plasticity of neuronal networks. Disruption of this gene is known to cause developmental delay and mental retardation. This report suggests that mutations affecting CNTN4 function may be relevant to ASD pathogenesis.
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Affiliation(s)
- J Roohi
- Department of Genetics, Stony Brook University, Stony Brook, New York, USA
| | - C Montagna
- Department of Pathology and Molecular Genetics, Albert Einstein College of Medicine, Bronx, New York, USA
| | - D H Tegay
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, New York, USA
- Department of Medicine & Medical Genetics, New York College of Osteopathic Medicine, Old Westbury, New York, USA
| | - L E Palmer
- Department of Microbiology, Stony Brook University, Stony Brook, New York, USA
| | - C DeVincent
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - J C Pomeroy
- Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, New York, USA
| | - S L Christian
- Department of Human Genetics, The University of Chicago, Chicago, Illinois, USA
| | - N Nowak
- Department of Cancer Prevention and Population Sciences, RPCI and New York State Center of Excellence in Bioinformatics and Life Sciences, University at Buffalo, New York, USA
| | - E Hatchwell
- Department of Genetics, Stony Brook University, Stony Brook, New York, USA
- Department of Pathology, Stony Brook University, Stony Brook, New York, USA
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