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McCormick CEB, Kavanaugh BC, Sipsock D, Righi G, Oberman LM, Moreno De Luca D, Gamsiz Uzun ED, Best CR, Jerskey BA, Quinn JG, Jewel SB, Wu PC, McLean RL, Levine TP, Tokadjian H, Perkins KA, Clarke EB, Dunn B, Gerber AH, Tenenbaum EJ, Anders TF, Sheinkopf SJ, Morrow EM. Autism Heterogeneity in a Densely Sampled U.S. Population: Results From the First 1,000 Participants in the RI-CART Study. Autism Res 2020; 13:474-488. [PMID: 31957984 DOI: 10.1002/aur.2261] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 01/25/2023]
Abstract
The objective of this study was to establish a large, densely sampled, U.S. population-based cohort of people with autism spectrum disorder (ASD). The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by ASD. Diagnosis was based on direct behavioral observation via the Autism Diagnostic Observation Schedule, Second Edition. For the first 1,000 participants, ages ranged from 21 months to 64 years. Using Geographic Information System and published prevalence rates, the overall cohort is estimated to represent between 20% and 49% of pediatric age persons in Rhode Island with ASD, with demographics representative of U.S. Census. We observed a high rate of co-occurring medical and psychiatric conditions in affected individuals. Among the most prominent findings of immediate clinical importance, we found that females received a first diagnosis of ASD at a later age than males, potentially due to more advanced language abilities in females with ASD. In summary, this is the first analysis of a large, population-based U.S. cohort with ASD. Given the depth of sampling, the RI-CART study reflects an important new resource for studying ASD in a representative U.S. population. Psychiatric and medical comorbidities in ASD constitute a substantial burden and warrant adequate attention as part of overall treatment. Our study also suggests that new strategies for earlier diagnosis of ASD in females may be warranted. Autism Res 2020, 13: 474-488. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: The Rhode Island Consortium for Autism Research and Treatment (RI-CART) represents a unique public-private-academic collaboration involving all major points of service for families in Rhode Island affected by autism spectrum disorder (ASD). In this article, we provide results from the first 1,000 participants, estimated to represent >20% of affected families in the state. Importantly, we find a later age at first diagnosis of ASD in females, which potentially calls attention to the need for improved early diagnosis in girls. Also, we report a high rate of co-occurring medical and psychiatric conditions in affected individuals.
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Affiliation(s)
- Carolyn E B McCormick
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Brian C Kavanaugh
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Danielle Sipsock
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Giulia Righi
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Lindsay M Oberman
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Daniel Moreno De Luca
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Ece D Gamsiz Uzun
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Pathology and Laboratory Medicine, Alpert Medical School of Brown University, Providence, Rhode Island.,Center for Computational Molecular Biology, Brown University, Providence, Rhode Island
| | - Carrie R Best
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Beth A Jerskey
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | | | - Pei-Chi Wu
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Rhode Island Hospital/Hasbro Children's Hospital, Providence, Rhode Island
| | - Rebecca L McLean
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Todd P Levine
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Hasmik Tokadjian
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Kayla A Perkins
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elaine B Clarke
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island
| | - Brittany Dunn
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Alan H Gerber
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Elena J Tenenbaum
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Thomas F Anders
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Stephen J Sheinkopf
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island.,Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island.,Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, Rhode Island
| | - Eric M Morrow
- Emma Pendleton Bradley Hospital, East Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Hassenfeld Child Health Innovation Institute, Brown University, Providence, Rhode Island.,Department of Molecular Biology, Cell Biology and Biochemistry, Brown University, Providence, Rhode Island.,Center for Translational Neuroscience, Robert J. and Nancy D. Carney Institute for Brain Science and Brown Institute for Translational Science, Brown University, Providence, Rhode Island
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Abstract
Early autism research focused on behavior and cognition. In recent decades, the pace of research has accelerated, and advances in imaging and genetics have allowed the accumulation of biological data. Nevertheless, a coherent picture of the syndrome at either phenotypic or biological level has not emerged. We see two fundamental obstacles to progress in basic understanding of autism. First, the two defining features (impairment in social interactions and communication, and restricted, repetitive behaviors and interests) are historically seen as integrally related. Others hold that these two major traits are fractionable and must be studied independently, casting doubt on autism as a coherent syndrome. Second, despite much recent research on brain structure and function, environmental factors, and genetics/genomics, findings on the biological level have not generally aligned well with those on the phenotypic level. In the first two sections, we explore these challenges, and in the third section, we review approaches that may facilitate progress, such as (1) including in studies all individuals defined by social impairment without regard to repetitive behaviors, (2) forming narrowly defined subtypes by thorough characterization on specific features, both diagnostic and non-diagnostic, (3) focusing on characteristics that may be relatively robust to environmental influence, (4) studying children as early as possible, minimizing environmental influence, and including longitudinal course as an important part of the phenotype, (5) subtyping by environmental risk factors, (6) distinguishing between what participants can do and what they typically do, and (7) aggregating large data sets across sites. (JINS, 2017, 23, 903-915).
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