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Gudbrandsen M, Daly E, Murphy CM, Wichers RH, Stoencheva V, Perry E, Andrews D, Blackmore CE, Rogdaki M, Kushan L, Bearden CE, Murphy DGM, Craig MC, Ecker C. The Neuroanatomy of Autism Spectrum Disorder Symptomatology in 22q11.2 Deletion Syndrome. Cereb Cortex 2019; 29:3655-3665. [PMID: 30272146 PMCID: PMC6644859 DOI: 10.1093/cercor/bhy239] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 08/10/2018] [Accepted: 09/03/2018] [Indexed: 12/29/2022] Open
Abstract
22q11.2 Deletion Syndrome (22q11.2DS) is a genetic condition associated with a high prevalence of neuropsychiatric conditions that include autism spectrum disorder (ASD). While evidence suggests that clinical phenotypes represent distinct neurodevelopmental outcomes, it remains unknown whether this translates to the level of neurobiology. To fractionate the 22q11.2DS phenotype on the level of neuroanatomy, we examined differences in vertex-wise estimates of cortical volume, surface area, and cortical thickness between 1) individuals with 22q11.2DS (n = 62) and neurotypical controls (n = 57) and 2) 22q11.2DS individuals with ASD symptomatology (n = 30) and those without (n = 25). We firstly observed significant differences in surface anatomy between 22q11.2DS individuals and controls for all 3 neuroanatomical features, predominantly in parietotemporal regions, cingulate and dorsolateral prefrontal cortices. We also established that 22q11.2DS individuals with ASD symptomatology were neuroanatomically distinct from 22q11.2DS individuals without ASD symptoms, particularly in brain regions that have previously been linked to ASD (e.g., dorsolateral prefrontal cortices and the entorhinal cortex). Our findings indicate that different clinical 22q11.2DS phenotypes, including those with ASD symptomatology, may represent different neurobiological subgroups. The spatially distributed patterns of neuroanatomical differences associated with ASD symptomatology in 22q11.2DS may thus provide useful information for patient stratification and the prediction of clinical outcomes.
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Affiliation(s)
- M Gudbrandsen
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - E Daly
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - C M Murphy
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - R H Wichers
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - V Stoencheva
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - E Perry
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - D Andrews
- The Medical Investigation of Neurodevelopmental Disorders (MIND) Institute and Department of Psychiatry and Behavioural Sciences, UC Davis School of Medicine, University of California Davis, Sacramento, CA, USA
| | - C E Blackmore
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - M Rogdaki
- Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College, London, UK
| | - L Kushan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - C E Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - D G M Murphy
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
| | - M C Craig
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- National Autism Unit, Bethlem Royal Hospital, London, UK
| | - C Ecker
- Department of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, UK
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Goethe-University Frankfurt am Main, Germany
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Ashwood KL, Gillan N, Horder J, Hayward H, Woodhouse E, McEwen FS, Findon J, Eklund H, Spain D, Wilson CE, Cadman T, Young S, Stoencheva V, Murphy CM, Robertson D, Charman T, Bolton P, Glaser K, Asherson P, Simonoff E, Murphy DG. Predicting the diagnosis of autism in adults using the Autism-Spectrum Quotient (AQ) questionnaire. Psychol Med 2016; 46:2595-2604. [PMID: 27353452 PMCID: PMC4988267 DOI: 10.1017/s0033291716001082] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 04/18/2016] [Accepted: 04/21/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Many adults with autism spectrum disorder (ASD) remain undiagnosed. Specialist assessment clinics enable the detection of these cases, but such services are often overstretched. It has been proposed that unnecessary referrals to these services could be reduced by prioritizing individuals who score highly on the Autism-Spectrum Quotient (AQ), a self-report questionnaire measure of autistic traits. However, the ability of the AQ to predict who will go on to receive a diagnosis of ASD in adults is unclear. METHOD We studied 476 adults, seen consecutively at a national ASD diagnostic referral service for suspected ASD. We tested AQ scores as predictors of ASD diagnosis made by expert clinicians according to International Classification of Diseases (ICD)-10 criteria, informed by the Autism Diagnostic Observation Schedule-Generic (ADOS-G) and Autism Diagnostic Interview-Revised (ADI-R) assessments. RESULTS Of the participants, 73% received a clinical diagnosis of ASD. Self-report AQ scores did not significantly predict receipt of a diagnosis. While AQ scores provided high sensitivity of 0.77 [95% confidence interval (CI) 0.72-0.82] and positive predictive value of 0.76 (95% CI 0.70-0.80), the specificity of 0.29 (95% CI 0.20-0.38) and negative predictive value of 0.36 (95% CI 0.22-0.40) were low. Thus, 64% of those who scored below the AQ cut-off were 'false negatives' who did in fact have ASD. Co-morbidity data revealed that generalized anxiety disorder may 'mimic' ASD and inflate AQ scores, leading to false positives. CONCLUSIONS The AQ's utility for screening referrals was limited in this sample. Recommendations supporting the AQ's role in the assessment of adult ASD, e.g. UK NICE guidelines, may need to be reconsidered.
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Affiliation(s)
- K. L. Ashwood
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - N. Gillan
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - J. Horder
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - H. Hayward
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - E. Woodhouse
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - F. S. McEwen
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
- Child & Adolescent Psychiatry,
Institute of Psychiatry, Psychology & Neuroscience, King's College
London, London, UK
- Social, Genetic & Developmental Psychiatry
(SGDP) Centre, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- Biological and Experimental Psychology,
School of Biological and Chemical Sciences, Queen Mary
University of London, London, UK
| | - J. Findon
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - H. Eklund
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - D. Spain
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - C. E. Wilson
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
- Individual Differences, Language and Cognition
Laboratory, Department of Developmental and Educational
Psychology, University of Seville,
Seville, Spain
| | - T. Cadman
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - S. Young
- Centre for Mental Health, Imperial College
London, London, UK
| | - V. Stoencheva
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - C. M. Murphy
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - D. Robertson
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
| | - T. Charman
- Department of Psychology,
Institute of Psychiatry, Psychology & Neuroscience, King's College
London, London, UK
| | - P. Bolton
- Social, Genetic & Developmental Psychiatry
(SGDP) Centre, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - K. Glaser
- Department of Social Science, Health &
Medicine, School of Social Science & Public
Policy, King's College London,
London, UK
| | - P. Asherson
- Social, Genetic & Developmental Psychiatry
(SGDP) Centre, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
| | - E. Simonoff
- Child & Adolescent Psychiatry,
Institute of Psychiatry, Psychology & Neuroscience, King's College
London, London, UK
| | - D. G. Murphy
- Department of Forensic and Neurodevelopmental
Sciences, Institute of Psychiatry, Psychology &
Neuroscience, King's College London, London,
UK
- South London and Maudsley National Health Service
Foundation Trust (SLAM), Maudsley Hospital,
London, UK
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