Short report: Autistic symptoms in Sotos syndrome, preliminary results from a case-control study

BACKGROUND

An extremely heterogeneous neuropsychological phenotype has been reported in Sotos Syndrome (SoS), including socio-communicative and behavioral difficulties referred to Autism Spectrum Disorder (ASD). Nonetheless, to date, only few data are available on the topic.

AIM

To investigate ASD symptoms within a sample of children with SoS in comparison to a matched control group of individuals with idiopathic ASD.

METHODS

A convenience sample of SoS (n = 33, age: 9.8 ± 4.1) and ASD (n = 33, age: 9.9 ± 4.1), was included. Autistic symptoms' assessment was performed through the administration of the Autism Diagnostic Observation Schedule-Second Edition- ADOS-2, the Social Responsiveness Scale -SRS and the Social Communication Questionnaire-SCQ.

RESULTS

72.7% of SoS children presented mild to moderate levels of ASD symptoms as measured by the ADOS-2. Oneway ANOVA analysis showed that SoS individuals presenting lower IQ demonstrated higher ASD symptom's level (p = 0.01). No statistically significant differences emerged between the SoS and ASD groups within the SRS total score domain (p = 0.95).

CONCLUSIONS AND IMPLICATIONS

Our results support the evidence for an increased risk for ASD in SoS, suggesting that the ASD symptoms' assessment should be regularly performed in SoS children, with subsequent important implications in terms of therapeutic strategies and later outcome.

Social responsiveness: The key ingredient to achieve social accountability in education and health care

While social accountability (SA) is regarded as an obligation or mandate for medical school administration, it runs the danger of becoming a bureaucratic checkbox. Compassion which leads to social responsiveness (SR), in contrast, is often recognized as an individual characteristic, detached from the public domain. The two, however, complement each other in practice. Institutions must be truly socially accountable, which is possible if there is spontaneous SR to the needs, and is fueled by compassion. Compassion in this article is defined as a "feeling for other people's sufferings, and the desire to act to relieve the suffering." Compassion has a long history, whereas SA is more recently described concept that follows the historical development of social justice. SR is the moral or ethical duty of an individual to behave in a way that benefits society. Not everyone feels the need to do something for others. Even if the need is felt, there may be a lack of will to act for the needs or to act effectively to fulfill the needs of society. The reasons are many, some visible and others not. SR provides the basis for being compassionate; hence, medical schools need to include SR as a criterion in their admissions process for student recruitment and inculcate compassion in health professions education and health care. By fostering SR and engaging compassion and self-compassion to achieve SA, we can humanize medical education systems and health care.

Responding to joint attention as a developmental catalyst: Longitudinal associations with language and social responsiveness

Joint attention (JA), infants' ability to engage in triadic attention with another person and a separate object or event, emerges in infancy. Responding to joint attention (RJA) develops earlier than initiating joint attention (IJA) and may benefit from a reconceptualization from a competence to a skill that varies in performance. Investigating associations between RJA performance and important skills of toddlerhood such as language, social responsiveness, and executive function (EF) in typically developing samples can better elucidate how RJA may serve as a developmental precursor to later dimensional skills, with implications for both typical and atypical development. Here, 210 (82% White) infants completed the Dimensional Joint Attention Assessment (DJAA), a naturalistic play-based assessment of RJA, at 8-15 months. At 16-38 months social responsiveness, verbal ability, and EF were assessed. Multilevel models showed that DJAA scores were associated with later verbal abilities and parent-reported social responsiveness. Exploratory analyses showed trend-level associations between RJA and EF. Results establish the content validity of the DJAA as a measure of RJA, and longitudinal associations with later verbal ability and social responsiveness. Future work should examine EF emergence and consolidation, and RJA and later EF associations.

An Exploratory Analysis on the 2D:4D Digit Ratio and Its Relationship with Social Responsiveness in Adults with Prader-Willi Syndrome

Prader-Willi syndrome (PWS) is a genetic disorder produced by a lack of expression of paternally derived genes in the 15q11-13 region. Research has generally focused on its genetic and behavioral expression, but only a few studies have examined epigenetic influences. Prenatal testosterone or the maternal testosterone-to-estradiol ratio (MaTtEr) has been suggested to play an important role in the development of the 'social brain' during pregnancy. Some studies propose the 2D:4D digit ratio of the hand as an indirect MaTtEr measure. The relationship between social performance and MaTtEr has been studied in other neurodevelopmental conditions such as Autism Spectrum Disorder (ASD), but to our best knowledge, it has never been studied in PWS. Therefore, our study aims to clarify the possible existence of a relationship between social performance-as measured using the Social Responsiveness Scale (SRS)-and MaTtEr levels using the 2D:4D ratio. We found that, as a group, PWS individuals have shorter index and ring fingers than the control group, but no significant difference in the 2D:4D ratios. The 2D:4D ratio showed a correlation only with Restricted Interests and Repetitive Behavior Subscale, where a positive correlation only for male individuals with PWS was found. Considering only PWS with previous GH treatment during childhood/adolescence (PWS-GH), index and ring fingers did not show differences in length with the control group, but the 2D:4D ratio was significantly higher in the right or dominant hand compared to controls.

Parent-Reported Social-Communicative Skills of Children with 22q11.2 Copy Number Variants and Siblings

22q11.2 deletion (22q11.2DS) and 22q11.2 duplication (22q11.2Dup) confer risk for neurodevelopmental difficulties, but the characterization of speech-language and social skills in 22q11.2Dup is still limited. Therefore, this study aims to delineate social-communicative skills in school-aged children with 22q11.2Dup (n = 19) compared to their non-carrier siblings (n = 11) and age-matched children with 22q11.2DS (n = 19). Parents completed two standardized questionnaires: the Children's Communication Checklist (CCC-2), screening speech, language, and social skills, and the Social Responsiveness Scales (SRS-2), assessing deficits in social behavior. Parents report that both children with 22q11.2Dup and 22q11.2DS show more social-communicative deficits than the general population; children with 22q11.2Dup seem to take an intermediate position between their siblings and children with 22q11.2DS. Compared to 22q11.2DS, they demonstrate less frequent and less severe problems, and more heterogeneous social-communicative profiles, with fewer restricted interests and repetitive behaviors. In siblings of 22q11Dup, milder social-communicative difficulties and equally heterogeneous profiles are reported, which might indicate that-in addition to the duplication-other factors such as the broader genetic context play a role in social-communicative outcomes.

Global and Regional Structural Differences and Prediction of Autistic Traits during Adolescence

BACKGROUND

Autistic traits are commonly viewed as dimensional in nature, and as continuously distributed in the general population. In this respect, the identification of predictive values of markers such as subtle autism-related alterations in brain morphology for parameter values of autistic traits could increase our understanding of this dimensional occasion. However, currently, very little is known about how these traits correspond to alterations in brain morphology in typically developing individuals, particularly during a time period where changes due to brain development processes do not provide a bias. Therefore, in the present study, we analyzed brain volume, cortical thickness (CT) and surface area (SA) in a cohort of 14-15-year-old adolescents (N = 285, female: N = 162) and tested their predictive value for autistic traits, assessed with the social responsiveness scale (SRS) two years later at the age of 16-17 years, using a regression-based approach. We found that autistic traits were significantly predicted by volumetric changes in the amygdala (r = 0.181), cerebellum (r = 0.128) and hippocampus (r = -0.181, r = -0.203), both in boys and girls. Moreover, the CT of the superior frontal region was negatively correlated (r = -0.144) with SRS scores. Furthermore, we observed a significant association between the SRS total score and smaller left putamen volume, specifically in boys (r = -0.217), but not in girls. Our findings suggest that neural correlates of autistic traits also seem to lie on a continuum in the general population, are determined by limbic-striatal neuroanatomical brain areas, and are partly dependent on sex. As we imaged adolescents from a large population-based cohort within a small age range, these data may help to increase the understanding of autistic-like occasions in otherwise typically developing individuals.

Social Responsiveness and Psychosocial Functioning in Adults with Prader-Willi Syndrome

Although various studies have investigated symptoms of autism spectrum disorder (ASD) in Prader−Willi syndrome (PWS), little is known about the consequences of these symptoms, especially in psychosocial function. We aimed to explore ASD symptoms in adults with PWS with special attention to psychosocial functionality. This cross-sectional study included 26 adults (15 women) with PWS who attended a reference unit for rare diseases. Participants’ primary caregivers completed the Social Responsiveness Scale (SRS), and clinicians assessed multidimensional functioning with the Personal and Social Performance Scale (PSP). Impaired social responsiveness was identified in 20 (76.9%) participants, and manifest to marked difficulties in social functioning were identified in 13 (50%). Participants with impaired social responsiveness (SRS ≥ 60) had significantly worse scores in functionality measured with the PSP (U = 12.5; p = 0.009) and with three of the four PSP main areas. Moreover, scores for the Social Cognition domain of the SRS correlated positively with the Socially useful activities (p < 0.05) and Personal and social relationships (p < 0.01) main areas of the PSP. These results suggest that difficulties in social skills should be assessed in all psychosocial evaluations of patients with PWS.

Autistic Traits and Social Responsiveness: The Relationship Between Autistic Traits and Comorbid Psychiatric Symptoms in Adolescents with Anorexia Nervosa

INTRODUCTION

It is known that patients with anorexia nervosa (AN) display social difficulties like social responsiveness and high levels of autistic behaviors such as rigidity, narrow interests of food and weight; however it is not clear whether they have comorbid Autism Spectrum Disorders (ASD) or it is about acute phase of illness. In this study it is aimed to investigate autistic traits and social responsiveness in adolescents with AN.

METHODS

Study group was consisted of 39 female AN patients aged between 12-18 years. Control group was consisted of 34 female adolescents who did not have any psychiatric disorder. K-SADS-PL was applied to all participants in order to detect the psychiatric disorders. Autism traits and social responsiveness were evaluated using Social Responsiveness Scale. All adolescents of the study were administered The Eating Attitude Test, Beck Depression Inventory, Screen for Child Anxiety and Related Disorders, Maudsley Obsesive Compulsive Inventory.

RESULTS

Results of the study indicated that adolescents with AN had higher symptoms of depression, anxiety and autism-like symptom clusters; and lower social responsiveness. Psychiatric comorbidities were not associated with these difficulties.

CONCLUSION

The results show that AN patients have an impairment of social responsiveness, the impairment seems to be associated with AN regardless of psychiatric comorbidities. Despite these two disorders are considered unrelated, they have several traits in common. These results suggest that there may be a common pathogenesis between ASD and AN.

Knowledge, Attitudes, and Social Responsiveness Toward Corona Virus Disease 2019 (COVID-19) Among Chinese Medical Students-Thoughts on Medical Education

Purpose: To assess knowledge, attitudes, and social responsiveness toward COVID-19 among Chinese medical students.

Methods: Self-administered questionnaires were used to collect data from 889 medical students in three well-known Chinese medical universities. The questionnaire was comprised of three domains which consisted of demographic characteristic collection, seven items for knowledge, and eight items for attitudes and social responsiveness toward COVID-19. Data from different universities were lumped together and were divided into different groups to compare the differences, including (1) students at the clinical learning stage (Group A) or those at the basic-medicine stage (Group B) and (2) students who have graduated and worked (Group C) or those newly enrolled (Group D).

Results: Medical students at group B had a weaker knowledge toward COVID-19 than did students at group A, especially in the question of clinical manifestations (p < 0.001). The percentage of totally correct answers of COVID-19 knowledge in group C was higher than that in Group D (p < 0.001). There were significant differences between groups C and D in the attitudes and social responsiveness toward COVID-19. Surprisingly, we found that the idea of newly enrolled medical students could be easily affected by interventions.

Conclusions: In light of this information, medical education should pay attention not only to the cultivation of professional knowledge and clinical skills but also to the positive interventions to better the comprehensive qualities including communicative abilities and empathy.

Infant Electroencephalogram Coherence and Toddler Inhibition are Associated with Social Responsiveness at Age 4

Previous work has suggested that individual differences in infant functional neuroconnectivity are a potential biomarker for later cognitive and social outcomes, but the mechanisms are unclear. This study investigated a longitudinal model of infant frontotemporal electroencephalogram (EEG) coherence predicting toddler inhibition, which then predicted childhood social responsiveness. A structural equation model showed good fit, with increased right hemisphere frontotemporal EEG coherence predicting less inhibition at age two, which in turn predicted less social responsiveness at age four. These findings support the hypothesis that infant frontotemporal connectivity is indirectly associated with later social behavior, with toddler inhibition as a potential mechanism.

Mothers of children with autism spectrum disorders: Play behaviors with infant siblings and social responsiveness

Mother-infant interactions are a proximal process in early development and may be especially salient for children who are at risk for social difficulties (i.e. infant siblings of children with autism spectrum disorder). To inform how indices of maternal behaviors may improve parent-mediated interventions designed to mitigate autism spectrum disorder risk, the present study explored maternal social responsiveness ratings and social behaviors during dyadic play interactions. Dyads were recruited from families with at least one older child with autism spectrum disorder (high-risk group, n = 90) or families with no history of autism spectrum disorder (low-risk group, n = 62). As part of a prospective study, interactions were coded when infant siblings were 6, 9, and 12 months of age, for gaze, affect, vocalizations, and multimodal bids or responses (i.e. social smiles). Maternal social responsiveness was indexed via the Social Responsiveness Scale. Mothers in both risk groups had comparable Social Responsiveness Scale scores and social behaviors during play. Two maternal behaviors emerged as positive correlates of infant social behaviors and are thus of high relevance to parent-mediated interventions. Specifically, more maternal positive affect and the use of multimodal bids or responses were associated with more infant positive affect, vocalizations, gaze to face, and multimodal bids or responses.

融合团体箱庭疗法对Asperger综合征儿童的疗效

OBJECTIVE

To study the clinical effect of integrated sandplay therapy in preschool children with Asperger syndrome (AS).

METHODS

A total of 44 preschool children with AS were randomly divided into an experimental group and a control group, with 22 children in each group. The children in the control group were given routine training, and those in the experimental group were given integrated sandplay therapy in addition to the routine training. The treatment response was assess by the Social Responsiveness Scale (SRS), emotional recognition tools and changes in sandplay theme characteristics after 6 months of treatment.

RESULTS

Before intervention, there were no significant differences between the two groups in the total score of SRS, the score of each factor of SRS, and correct rates of facial expression recognition of the upright position, inverted position, upper face and lower face (P>0.05). After 6 months of intervention, both groups had significant reductions in the total score of SRS and the score of each factor of SRS (P<0.01); the control group had significant increases in the correct rates of facial expression recognition of all positions except the upright position (P<0.05), while the experimental group had significant increases in the correct rates of facial expression recognition of all positions (P<0.05). Compared with the control group after intervention, the experimental group had significantly lower total score of SRS and scores of all factors of SRS except social perception (P<0.01) and significantly higher correct rates of facial expression recognition of all positions (P<0.01). The experimental group had a significant change in the number of sandplay theme characteristics after intervention (P<0.01).

CONCLUSIONS

Integrated sandplay therapy can improve social responsiveness and emotion recognition ability in preschool children with AS.

[Clinical effect of integrated sandplay therapy in children with Asperger syndrome]

OBJECTIVE

To study the clinical effect of integrated sandplay therapy in preschool children with Asperger syndrome (AS).

METHODS

A total of 44 preschool children with AS were randomly divided into an experimental group and a control group, with 22 children in each group. The children in the control group were given routine training, and those in the experimental group were given integrated sandplay therapy in addition to the routine training. The treatment response was assess by the Social Responsiveness Scale (SRS), emotional recognition tools and changes in sandplay theme characteristics after 6 months of treatment.

RESULTS

Before intervention, there were no significant differences between the two groups in the total score of SRS, the score of each factor of SRS, and correct rates of facial expression recognition of the upright position, inverted position, upper face and lower face (P>0.05). After 6 months of intervention, both groups had significant reductions in the total score of SRS and the score of each factor of SRS (P<0.01); the control group had significant increases in the correct rates of facial expression recognition of all positions except the upright position (P<0.05), while the experimental group had significant increases in the correct rates of facial expression recognition of all positions (P<0.05). Compared with the control group after intervention, the experimental group had significantly lower total score of SRS and scores of all factors of SRS except social perception (P<0.01) and significantly higher correct rates of facial expression recognition of all positions (P<0.01). The experimental group had a significant change in the number of sandplay theme characteristics after intervention (P<0.01).

CONCLUSIONS

Integrated sandplay therapy can improve social responsiveness and emotion recognition ability in preschool children with AS.

Using a robotic fish to investigate individual differences in social responsiveness in the guppy

Responding towards the actions of others is one of the most important behavioural traits whenever animals of the same species interact. Mutual influences among interacting individuals may modulate the social responsiveness seen and thus make it often difficult to study the level and individual variation in responsiveness. Here, open-loop biomimetic robots that provide standardized, non-interactive social cues can be a useful tool. These robots are not affected by the live animal's actions but are assumed to still represent valuable and biologically relevant social cues. As this assumption is crucial for the use of biomimetic robots in behavioural studies, we hypothesized (i) that meaningful social interactions can be assumed if live animals maintain individual differences in responsiveness when interacting with both a biomimetic robot and a live partner. Furthermore, to study the level of individual variation in social responsiveness, we hypothesized (ii) that individual differences should be maintained over the course of multiple tests with the robot. We investigated the response of live guppies (Poecilia reticulata) when allowed to interact either with a biomimetic open-loop-controlled fish robot-'Robofish'-or with a live companion. Furthermore, we investigated the responses of live guppies when tested three times with Robofish. We found that responses of live guppies towards Robofish were weaker compared with those of a live companion, most likely as a result of the non-interactive open-loop behaviour of Robofish. Guppies, however, were consistent in their individual responses between a live companion and Robofish, and similar individual differences in response towards Robofish were maintained over repeated testing even though habituation to the test environment was detectable. Biomimetic robots like Robofish are therefore a useful tool for the study of social responsiveness in guppies and possibly other small fish species.

Extending the 'cross-disorder' relevance of executive functions to dimensional neuropsychiatric traits in youth

BACKGROUND

Evidence that different neuropsychiatric conditions share genetic liability has increased interest in phenotypes with 'cross-disorder' relevance, as they may contribute to revised models of psychopathology. Cognition is a promising construct for study; yet, evidence that the same cognitive functions are impaired across different forms of psychopathology comes primarily from separate studies of individual categorical diagnoses versus controls. Given growing support for dimensional models that cut across traditional diagnostic boundaries, we aimed to determine, within a single cohort, whether performance on measures of executive functions (EFs) predicted dimensions of different psychopathological conditions known to share genetic liability.

METHODS

Data are from 393 participants, ages 8-17, consecutively enrolled in the Longitudinal Study of Genetic Influences on Cognition (LOGIC). This project is conducting deep phenotyping and genomic analyses in youth referred for neuropsychiatric evaluation. Using structural equation modeling, we examined whether EFs predicted variation in core dimensions of the autism spectrum disorder, bipolar illness, and schizophrenia (including social responsiveness, mania/emotion regulation, and positive symptoms of psychosis, respectively).

RESULTS

We modeled three cognitive factors (working memory, shifting, and executive processing speed) that loaded on a second-order EF factor. The EF factor predicted variation in our three target traits, but not in a negative control (somatization). Moreover, this EF factor was primarily associated with the overlapping (rather than unique) variance across the three outcome measures, suggesting that it related to a general increase in psychopathology symptoms across those dimensions.

CONCLUSIONS

Findings extend support for the relevance of cognition to neuropsychiatric conditions that share underlying genetic risk. They suggest that higher-order cognition, including EFs, relates to the dimensional spectrum of each of these disorders and not just the clinical diagnoses. Moreover, results have implications for bottom-up models linking genes, cognition, and a general psychopathology liability.

Effects of maternal chlorpyrifos diet on social investigation and brain neuroendocrine markers in the offspring - a mouse study

BACKGROUND

Chlorpyrifos (CPF) is one of the most widely used organophosphate pesticides worldwide. Epidemiological studies on pregnant women and their children suggest a link between in utero CPF exposure and delay in psychomotor and cognitive maturation. A large number of studies in animal models have shown adverse effects of CPF on developing brain and more recently on endocrine targets. Our aim was to determine if developmental exposure to CPF affects social responsiveness and associated molecular neuroendocrine markers at adulthood.

METHOD

Pregnant CD1 outbred mice were fed from gestational day 15 to lactation day 14 with either a CPF-added (equivalent to 6 mg/kg/bw/day during pregnancy) or a standard diet. We then assessed in the offspring the long-term effects of CPF exposure on locomotion, social recognition performances and gene expression levels of selected neurondocrine markers in amygdala and hypothalamus.

RESULTS

No sign of CPF systemic toxicity was detected. CPF induced behavioral alterations in adult offspring of both sexes: CPF-exposed males displayed enhanced investigative response to unfamiliar social stimuli, whereas CPF-exposed females showed a delayed onset of social investigation and lack of reaction to social novelty. In parallel, molecular effects of CPF were sex dimorphic: in males CPF increased expression of estrogen receptor beta in hypothalamus and decreased oxytocin expression in amygdala; CPF increased vasopressin 1a receptor expression in amygdala in both sexes.

CONCLUSIONS

These data indicate that developmental CPF affects mouse social behavior and interferes with development of sex-dimorphic neuroendocrine pathways with potential disruptive effects on neuroendocrine axes homeostasis. The route of exposure selected in our study corresponds to relevant human exposure scenarios, our data thus supports the view that neuroendocrine effects, especially in susceptible time windows, should deserve more attention in risk assessment of OP insecticides.

Social responsiveness, an autism endophenotype: genomewide significant linkage to two regions on chromosome 8

OBJECTIVE

Autism spectrum disorder is characterized by deficits in social function and the presence of repetitive and restrictive behaviors. Following a previous test of principle, the authors adopted a quantitative approach to discovering genes contributing to the broader autism phenotype by using social responsiveness as an endophenotype for autism spectrum disorder.

METHOD

Linkage analyses using scores from the Social Responsiveness Scale were performed in 590 families from the Autism Genetic Resource Exchange, a largely multiplex autism spectrum disorder cohort. Regional and genomewide association analyses were performed to search for common variants contributing to social responsiveness.

RESULTS

Social Responsiveness Scale scores were unimodally distributed in male offspring from multiplex autism families, in contrast with a bimodal distribution observed in female offspring. In correlated analyses differing by Social Responsiveness Scale respondent, genomewide significant linkage for social responsiveness was identified at chr8p21.3 (multipoint LOD=4.11; teacher/parent scores) and chr8q24.22 (multipoint LOD=4.54; parent-only scores), respectively. Genomewide or linkage-directed association analyses did not detect common variants contributing to social responsiveness.

CONCLUSIONS

The sex-differential distributions of Social Responsiveness Scale scores in multiplex autism families likely reflect mechanisms contributing to the sex ratio for autism observed in the general population and form a quantitative signature of reduced penetrance of inherited liability to autism spectrum disorder among females. The identification of two strong loci for social responsiveness validates the endophenotype approach for the identification of genetic variants contributing to complex traits such as autism spectrum disorder. While causal mutations have yet to be identified, these findings are consistent with segregation of rare genetic variants influencing social responsiveness and underscore the increasingly recognized role of rare inherited variants in the genetic architecture of autism spectrum disorder.

Social behaviors increase more when children with ASD are imitated by their mother vs. an unfamiliar adult

Previous research suggests that being imitated by an adult increases the social behaviors of children with an autism spectrum disorder (ASD). In the current study, we examined whether familiarity with the imitating social partner modulates this effect. Ten children with ASD and their mothers participated. The children's social behaviors were observed prior to and following a 3-min period in which an adult social partner imitated everything they did. In one condition the partner was the child's mother, and in the other condition the partner was an unfamiliar experimenter. The results revealed significant increases in distal social behaviors (gazes toward the adult, vocalizing) following imitation by both partners. There was a significantly greater increase in proximal social behaviors (including approach, being physically close, and touching) and a greater decrease in playing alone when the imitator was the child's mother as opposed to the experimenter. The findings suggest that the experience of being imitated creates an atmosphere of mutuality and rapport between children with ASD and their social partners, which increases their sociability even in interactions with already familiar adults.