Quantitative autistic traits ascertained in a national survey of 22 529 Japanese schoolchildren

Developmental changes in attention to social information from childhood to adolescence in autism spectrum disorders: a comparative study

BACKGROUND

Elucidating developmental changes in the symptoms of autism spectrum disorder (ASD) is important to support individuals with ASD. However, no report has clarified the developmental changes in attention to social information for a broad age range. The aim of this study was to investigate the developmental changes in attention to social information from early childhood to adolescence in individuals with ASD and typically developed (TD) children.

METHODS

We recruited children with ASD (n = 83) and TD participants (n = 307) between 2 and 18 years of age. Using the all-in-one-eye-tracking system, Gazefinder, we measured the percentage fixation time allocated to areas of interest (AoIs) depicted in movies (the eyes and mouth in movies of a human face with/without mouth motion, upright and inverted biological motion in movies showing these stimuli simultaneously, people and geometry in preference paradigm movies showing these stimuli simultaneously, and objects with/without finger-pointing in a movie showing a woman pointing toward an object). We conducted a three-way analysis of variance, 2 (diagnosis: ASD and TD) by 2 (sex: male and female) by 3 (age group: 0-5, 6-11, and 12-18 years) and locally weighted the scatterplot smoothing (LOESS) regression curve on each AoI.

RESULTS

In the face stimuli, the percentage fixation time to the eye region for the TD group increased with age, whereas the one for the ASD group did not. In the ASD group, the LOESS curves of the gaze ratios at the eye region increased up to approximately 10 years of age and thereafter tended to decrease. For the percentage fixation time to the people region in the preference paradigm, the ASD group gazed more briefly at people than did the TD group.

LIMITATIONS

It is possible that due to the cross-sectional design, the degree of severity and of social interest might have differed according to the subjects' age.

CONCLUSIONS

There may be qualitative differences in abnormal eye contact in ASD between individuals in early childhood and those older than 10 years.

Prevalence estimates of neurodevelopmental disorders in Japan: A community sample questionnaire study

AIM

Prevalence estimates of neurodevelopmental disorders have been calculated by questionnaire surveys scored by a single rater, which introduces inherent rater biases. The present study aimed to estimate the prevalence and comorbidity rates of four neurodevelopmental disorders based on both parent and teacher rating scales.

METHODS

We performed a community sample survey recruiting 3852 children aged 6 to 9 years. Parents and teachers evaluated clinical conditions in children using questionnaire-style scales. These scales with cut-off values were used to estimate the prevalence and comorbidity rates of attention deficit hyperactive disorder, autism spectrum disorder, specific learning disorder (or developmental dyslexia), and developmental coordination disorder.

RESULTS

The prevalence estimates were separately confirmed according to the raters. Some estimates were higher than those in previous studies conducted in other countries. We also found a large disagreement between the parent and teacher rating scores. Moreover, the degree of agreement between two raters varied depending on the severity of the child's clinical condition.

CONCLUSION

These estimates are the first findings based on evaluating children by two different raters. The prevalence and comorbidity estimates are informative for researchers and clinicians of pediatric neurology. The disagreements between two different raters raise questions about previous estimates of neurodevelopmental disorders.

The Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL) for DSM-5: A validation for neurodevelopmental disorders in Japanese outpatients

OBJECTIVE

The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) is a widely used semi-structured diagnostic interview in child and adolescent psychiatry. However, given the extensive use of the K-SADS-PL in clinical practice and research and its adaptation for use in many languages and cultures, validation studies of the instrument are scarce. This study was designed to examine the inter-rater reliability, criterion validity and construct validity of the updated instrument, the K-SADS-PL for DSM-5, in Japanese outpatients totaling 95 children and adolescents.

METHOD

We translated and adapted the updated instrument into Japanese using a standard forward-backward translation procedure. Two of nine experienced clinicians independently made diagnoses using the interview for each patient in a conjoint session. Discrepancies in diagnosis between two clinicians were resolved by consensus, and the consensus diagnosis was compared with a "best-estimate" diagnosis made by five experienced clinicians using all available data sources for patients who were blinded to the diagnosis using the K-SADS-PL for DSM-5. The "best-estimate" diagnosis of ASD was also based on the Diagnostic Interview for Social and Communication Disorders.

RESULTS

The inter-rater reliability was very good, as shown by κ ≥ 0.8 for all disorders examined: autism spectrum disorder (ASD), attention-deficit hyperactivity disorder, tic disorders, selective mutism, enuresis and encopresis. The criterion validity was good, as shown by κ ≥ 0.6 for all disorders examined, except for ASD (κ = 0.59). This study also revealed good construct validity of the instrument by confirming the expected associations with each scale from the Social Responsiveness Scale-2nd edition and the Strengths and Difficulties Questionnaire.

CONCLUSION

These results suggest that the K-SADS-PL for DSM-5 generates valid diagnoses in child and adolescent psychiatry.

Assessing autism in females: The importance of a sex-specific comparison

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.

Prevalence and Characteristics of Autism Spectrum Disorder Among Spanish School-Age Children

The present study aims to assess the prevalence of autism spectrum disorder (ASD) in preschool and school-age children following a two-phase procedure. The screening phase was performed on a sample of 5555 children taking into account parent and teacher information. The individual assessment included the ADI-R, ADOS-2 and Wechsler scales. The estimated prevalence was 1.55% in preschoolers and 1.00% in school-age children. Between 1.84 and 2.59% of the children exhibited subclinical diagnosis. The male-to-female ratio was around 4:1. Most of the children exhibited mild and moderate nuclear symptoms, and the girls showed less severe communication problems. Previous diagnosis was found in 62-71% of the children. Prevalence estimates are close to the 1% international ratings and much higher than previous national reports suggested.

Quantifying individual differences in brain morphometry underlying symptom severity in Autism Spectrum Disorders

The neurobiology of heterogeneous neurodevelopmental disorders such as autism spectrum disorders (ASD) are still unclear. Despite extensive efforts, most findings are difficult to reproduce due to high levels of individual variance in phenotypic expression. To quantify individual differences in brain morphometry in ASD, we implemented a novel subject-level, distance-based method on subject-specific attributes. In a large multi-cohort sample, each subject with ASD (n = 100; n = 84 males; mean age: 11.43 years; mean IQ: 110.58) was strictly matched to a control participant (n = 100; n = 84 males; mean age: 11.43 years; mean IQ: 110.70). Intrapair Euclidean distance of MRI brain morphometry and symptom severity measures (Social Responsiveness Scale) were entered into a regularised machine learning pipeline for feature selection, with rigorous out-of-sample validation and permutation testing. Subject-specific structural morphometry features significantly predicted individual variation in ASD symptom severity (19 cortical thickness features, p = 0.01, n = 5000 permutations; 10 surface area features, p = 0.006, n = 5000 permutations). Findings remained robust across subjects and were replicated in validation samples. Identified cortical regions implicate key hubs of the salience and default mode networks as neuroanatomical features of social impairment in ASD. Present results highlight the importance of subject-level markers in ASD, and offer an important step forward in understanding the neurobiology of heterogeneous disorders.

Brief Report: A Novel System to Evaluate Autism Spectrum Disorders Using Two Humanoid Robots

We investigated the feasibility of our novel evaluation system for use with children with autism spectrum disorders (ASD). We prepared the experimental setting with two humanoid robots in reference to the birthday party scene in the Autism Diagnostic Observational Schedule (ADOS). We assessed the relationship between social communication ability measured in the ADOS condition (i.e., with a human clinician) and in a robotic condition for children with ASD. There were significant correlations between the social communication scores in the gold-standard ADOS condition and the robotic condition for children with ASD. The current work provides support for a unique application of a robotic system (i.e., two robot-mediated interaction) to evaluate the severity of autistic traits for children with ASD.

Atypical body movements during night in young children with autism spectrum disorder: a pilot study

Children with autism spectrum disorder (ASD) reportedly suffer from sleep problems at a higher rate than typically developing (TD) children. Several previous studies have reported differences in sleep indices (e.g., sleep latency) in children with ASD. However, no previous studies have focused specifically on the time course of body movements. In the present study, we investigated the time course of body movements in young TD children and young children with ASD as well as the relationship between body movements during night and social ability. Seventeen TD children and 17 children with ASD participated in this study (5 to 8 years old). We used an accelerometer attached to the waist to record movements during night and measured the average time course of body movements for 3 nights. Our results demonstrated that the rate of body movement 2 to 3 hours after the onset of body stillness was higher in children with ASD than in TD children. In addition, the higher rate of body movement at 0.5 to 1 hour after the onset of body stillness was associated with a lower social ability in the children with ASD. Our results suggested that the time course of body movements is an objective behavioural index for young children with ASD.

Sensory processing in children with autism spectrum disorder and the mental health of primary caregivers

BACKGROUND

Sensory processing difficulties, which commonly occur in autism spectrum disorder (ASD), are expected to have negative effects on the primary caregiver's mental health. The aim of this study was to examine the association between sensory processing difficulties in children with ASD and the mental health of primary caregivers.

METHODS

A total of 707 primary caregivers (mothers in the present study) and their children with ASD (4-18 years of age) participated in this study. Sensory processing difficulties were indexed using the Short Sensory Profile (SSP). The mental health of primary caregivers was indexed using the General Health Questionnaire (GHQ12).

RESULTS

Higher scores on Auditory Filtering as measured with the SSP were associated with poorer mental health of primary caregivers, even after an adjustment for ASD symptom severity. Analyses of two age sub-groups, a young (4-10 years) and an old age group (11-18 years), revealed that higher scores on Tactile Sensitivity and Auditory Filtering were associated with poorer mental health of primary caregivers in younger children, whereas only higher scores on Auditory Filtering were associated with poorer mental health of primary caregivers in older children.

CONCLUSIONS

Our findings suggest that practitioners who support primary caregivers of children with ASD need to focus not only on the social and communication-related symptoms of the child but also on their specific sensory processing difficulties.

Autism Spectrum Disorder: Incidence and Time Trends Over Two Decades in a Population-Based Birth Cohort

We retrospectively identified autism spectrum disorder (ASD) incident cases among 31,220 individuals in a population-based birth cohort based on signs and symptoms uniformly abstracted from medical and educational records. Inclusive and narrow research definitions of ASD (ASD-RI and ASD-RN, respectively) were explored, along with clinical diagnoses of ASD (ASD-C) obtained from the records. The incidence of ASD-RI, ASD-RN, and ASD-C increased significantly from 1985 to 1998, then ASD-RI and ASD-RN plateaued while the rate of ASD-C continued to increase during 1998-2004. The rising incidence of research-defined ASD may reflect improved recognition and documentation of ASD signs and symptoms. Although the frequency of threshold ASD symptoms stabilized, the rate of ASD-C continued to increase, narrowing the gap between clinical ascertainment and symptom documentation.

Negatively Skewed Locomotor Activity Is Related to Autistic Traits and Behavioral Problems in Typically Developing Children and Those With Autism Spectrum Disorders

An important objective for researchers and clinicians is to gain a better understanding of the factors that underlie autism spectrum disorders (ASDs). It is possible that investigating objective and quantitative behavioral phenotypes and their relationship to clinical characteristics, such as autistic traits and other emotional/behavioral problems, might facilitate this process. Given this, in the current study we examined the link between locomotor dynamics and clinical characteristics, including autistic traits and emotional/behavioral problems, in children with ASD (n = 14) and typically developing (TD) children (n = 13). A watch-type actigraph was used to continuously measure locomotor activity which was assessed in terms of mean activity levels and the skewness of activity. Parents assessed quantitative autistic traits using the Japanese version of the Social Responsiveness Scale (SRS) and emotional and behavioral problems using the Japanese version of the Strengths and Difficulties Questionnaire (SDQ). Results showed that among all children, all-day activity was more negatively skewed, suggesting sporadic large all-day "troughs" in activity and was significantly correlated with the SRS social awareness subscale score (ρ = -0.446, p = 0.038). In addition, the more negatively skewed daytime locomotor activity was associated with the SDQ Hyperactivity Inattention subscale score (ρ = -0.493, p = 0.020). The results of this study indicate that investigating locomotor dynamics may provide one way to increase understanding of the neurophysiological mechanisms underlying the clinical characteristics of ASD.

Stability of Autistic Traits from 5 to 8 Years of Age Among Children in the General Population

Little is known about the across time stability of autistic traits during the transition period from preschool to school age in the general population. The current study compared autistic traits assessed by a mother-reported quantitative measure, the Social Responsiveness Scale, at age 5 and 8 years and examined the intraclass correlation coefficients of scores across the period for 168 Japanese community-based children. Results showed that total and two subdomain-related autistic trait scores remained primarily stable in males and females. This stability was observed for both children with higher and lower autistic traits scores with a possible sex-specific pattern. Our findings suggest that autistic traits in the general population can be reliably assessed using quantitative measures for this age period.

Prevalence of autism traits and attention-deficit hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain

Purpose

Recent research has suggested that autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) may be comorbid to pediatric chronic pain, but the empirical support is yet scarce. Therefore, the current study aimed to investigate the occurrence of traits and symptoms consistent with clinically significant ASD and ADHD in a group of children and adolescents with chronic debilitating pain and examine potential differences in pain and demographic variables between children with and without clinically significant traits and symptoms of ASD and ADHD.

Patients and methods

This cross-sectional study included 146 parent–child dyads (102 girls, 111 mothers, children 8–17 years) consecutively referred to a tertiary pain clinic. Parents completed the Social Responsiveness Scale to assess autistic traits, and Conners-3 to measure symptoms of ADHD in their children. Children completed the Lübeck Pain Questionnaire to evaluate experienced pain.

Results

Among children, 20 (13.7%) received scores consistent with clinically significant ASD and 29 (19.9%) received scores consistent with clinically significant ADHD, with a combined prevalence of clinically significant ASD/ADHD traits and symptoms of 26% of the total sample. Only 4.8% of children were previously diagnosed with either disorder. Among children with clinically significant ASD traits, girls were more prevalent, parents reported lower health, and the pain was more likely triggered by being in school. Among children with clinically significant ADHD symptoms, there were no gender differences and pain was more likely triggered by the family situation and new situations. No differences regarding pain intensity, duration, or frequency were found between children with and without clinically significant ASD traits or ADHD symptoms.

Conclusion

Children with debilitating chronic pain, particularly girls, may present with an elevated risk of having a comorbid, possibly high-functioning, neurodevelopmental disorder. Results suggest that clinical assessment of pediatric chronic pain should include screening for neurodevelopmental disorders.

Autism-Related Variation in Reciprocal Social Behavior: A Longitudinal Study

Deficits in reciprocal social behavior are a characterizing feature of autism spectrum disorder (ASD). Autism‐related variation in reciprocal social behavior (AVR) in the general population is continuously distributed and highly heritable—a function of additive genetic influences that overlap substantially with those which engender clinical autistic syndromes. This is the first long‐term prospective study of the stability of AVR from childhood through early adulthood, conducted via serial ratings using the Social Responsiveness Scale, in a cohort‐sequential study involving children with ASD, other psychiatric conditions, and their siblings (N = 602, ages = 2.5–29). AVR exhibits marked stability throughout childhood in individuals with and without ASD.

Relationship between Autistic Spectrum Trait and Regional Cerebral Blood Flow in Healthy Male Subjects

OBJECTIVE

Autistic spectrum traits are postulated to lie on a continuum that extends between individuals with autism and individuals with typical development. The present study was carried out to investigate functional and network abnormalities associated with autistic spectrum trait in healthy male subjects.

METHODS

Subjects were 41 healthy male subjects who underwent the social responsiveness scale-adult (SRS-A) and magnetic resonance imaging.

RESULTS

There was significant positive correlation between the total score of SRS-A and the regional cerebral blood flow (CBF) in posterior cingulate cortex (PCC). Also, there were changes in functional network such as in cingulate corti, insula and fusiform cortex. Further, we also found the significant difference of functional networks between the healthy male subjects with high or low autistic spectrum trait, and these points were congruent with the previous perceptions derived from autistic-spectrum disorders.

CONCLUSION

These findings suggest a biological basis for the autistic spectrum trait and may be useful for the imaging marker of autism symptomatology.

Changes in maternal feelings for children with autism spectrum disorder after childbirth: The impact of knowledge about the disorder

The social interactions between caregivers and their children play a crucial role in childhood development; therefore, caregivers’ feelings for children are critical for the development of social minds. Mothers of children with autism spectrum disorder (ASD) are known to experience higher levels of stress. However, knowledge regarding mothers’ feelings for their children before receiving a clinical diagnosis is limited. This study retrospectively investigated the time course of mothers’ feelings from the time of birth and the effect of protective factors. The participants were 5- to 8-year-old children with an ASD diagnosis and their mothers. The mothers of the children with ASD had less positive feelings toward their children than the mothers of the typically developed (TD) children before receiving a clinical diagnosis. Intriguingly, prior knowledge of ASD may relieve maternal mental distress during the child-rearing years and at the time of diagnosis.

Association Between Autistic Traits in Preschool Children and Later Emotional/Behavioral Outcomes

Although children with a greater number of autistic traits are likely to have other mental health problems, research on the association between earlier autistic traits in preschool children and later emotional/behavioral outcomes is scarce. Using data from 189 Japanese community-based children, this study examined whether autistic traits at age 5 were related to emotional/behavioral outcomes at age 7. The results showed that prior autistic traits were subsequently associated with all emotional/behavioral domains. After controlling for baseline emotional/behavioral scores autistic traits continued to predict later emotional symptoms and peer problems. This study highlights that in addition to clinical ASD, it is also important to focus on subthreshold autistic traits in preschool children for better subsequent emotional/behavioral outcomes.

Individual differences and the effect of face configuration information in the McGurk effect

The McGurk effect, which denotes the influence of visual information on audiovisual speech perception, is less frequently observed in individuals with autism spectrum disorder (ASD) compared to those without it; the reason for this remains unclear. Several studies have suggested that facial configuration context might play a role in this difference. More specifically, people with ASD show a local processing bias for faces-that is, they process global face information to a lesser extent. This study examined the role of facial configuration context in the McGurk effect in 46 healthy students. Adopting an analogue approach using the Autism-Spectrum Quotient (AQ), we sought to determine whether this facial configuration context is crucial to previously observed reductions in the McGurk effect in people with ASD. Lip-reading and audiovisual syllable identification tasks were assessed via presentation of upright normal, inverted normal, upright Thatcher-type, and inverted Thatcher-type faces. When the Thatcher-type face was presented, perceivers were found to be sensitive to the misoriented facial characteristics, causing them to perceive a weaker McGurk effect than when the normal face was presented (this is known as the McThatcher effect). Additionally, the McGurk effect was weaker in individuals with high AQ scores than in those with low AQ scores in the incongruent audiovisual condition, regardless of their ability to read lips or process facial configuration contexts. Our findings, therefore, do not support the assumption that individuals with ASD show a weaker McGurk effect due to a difficulty in processing facial configuration context.

Correlation of reduced social communicational and interactional skills with regional grey matter volumes in schizophrenia patients

OBJECTIVE

Recent studies have detected similarities between autism spectrum disorder and schizophrenia. We investigated structural abnormalities associated with autistic-like traits in patients with schizophrenia by voxel-based morphometry.

METHODS

Patients with schizophrenia and healthy subjects were evaluated by the adult version of the social responsiveness scale (SRS-A), which is sensitive to autistic traits and symptoms even under subthreshold conditions, and magnetic resonance imaging.

RESULTS

There were significant decreases in the anterior cingulate cortex, bilateral hippocampi, cerebellums, and right insula of patients with schizophrenia, compared with healthy subjects. We found significant negative correlations of the social communication and interaction (SCI) score, a subscale of SRS-A, with grey matter volume in the left posterior superior temporal region of schizophrenia patients. When subscales of SCI were examined separately in schizophrenic patients, negative correlations were observed between the social cognition score and the volumes of the left posterior superior temporal region, and between social motivation and the posterior cingulate cortex.

CONCLUSION

We found significant negative correlation between the SCI score and the grey matter volume in the left posterior superior temporal region of schizophrenia patients. This area was the region affected in previous studies of autistic spectrum disorders. Further, this area was associated with the theory of mind. Schizophrenia patients not necessarily show the impairment of SCI, nor this correlated region was not always the point with schizophrenia-specific change. However, we reveal the relationship between the left posterior superior temporal gyrus and the severity of the SCI in schizophrenia by using with SRS-A.

Clinical impact of early diagnosis of autism on the prognosis and parent-child relationships

Autism spectrum disorder (ASD) refers to a lifelong condition that usually appears in late infancy or early childhood, and is characterized by social and communication deficits that impede optimal functioning. Despite widespread research and greater public awareness, ASD has an unclear etiology and no known cure, making it difficult to acquire accurate and timely diagnoses. In addition, once an ASD diagnosis is made, parents find it challenging to navigate the healthcare system and determine which interventions are most effective and appropriate for their child. A growing body of evidence supports the value of early diagnosis and treatment with evidence-based interventions, which can significantly improve the quality of life of individuals with ASD as well as of their carers and families. Particularly noteworthy are early interventions that occur in natural surroundings and can be modified to address age-related goals throughout the lifespan. Therefore, the purpose of this review is to: 1) provide readers with a brief background related to ASD; 2) describe commonly used screening instruments and tools for early diagnosis; 3) describe early interventions that have empirical support; and 4) discuss how the parent-child and family relationships can be affected through this process. This information can provide professionals with information they can use to assist families who make critical and potentially life-changing decisions for children with ASD.

Association Between Autistic Traits in Preschool Children and Later Emotional/Behavioral Outcomes

Although children with a greater number of autistic traits are likely to have other mental health problems, research on the association between earlier autistic traits in preschool children and later emotional/behavioral outcomes is scarce. Using data from 189 Japanese community-based children, this study examined whether autistic traits at age 5 were related to emotional/behavioral outcomes at age 7. The results showed that prior autistic traits were subsequently associated with all emotional/behavioral domains. After controlling for baseline emotional/behavioral scores autistic traits continued to predict later emotional symptoms and peer problems. This study highlights that in addition to clinical ASD, it is also important to focus on subthreshold autistic traits in preschool children for better subsequent emotional/behavioral outcomes.

Assessment of Autistic Traits in Children Aged 2 to 4½ Years With the Preschool Version of the Social Responsiveness Scale (SRS-P): Findings from Japan

The recent development and use of autism measures for the general population has led to a growing body of evidence which suggests that autistic traits are distributed along a continuum. However, as most existing autism measures were designed for use in children older than age 4, to date, little is known about the autistic continuum in children younger than age 4. As autistic symptoms are evident in the first few years, to address this research gap, the current study tested the preschool version of the Social Responsiveness Scale (SRS‐P) in children aged 2 to 4½ years in clinical (N = 74, average age 40 months, 26–51 months) and community settings (N = 357, average age 39 months, 25–50 months) in Japan. Using information obtained from different raters (mothers, other caregivers, and teachers) it was found that the scale demonstrated a good degree of internal consistency, inter‐rater reliability and test‐retest reliability, and a satisfactory degree of convergent validity for the clinical sample when compared with scores from diagnostic “gold standard” autism measures. Receiver operating characteristic analyses and the group comparisons also showed that the SRS‐P total score discriminated well between children with autism spectrum disorder (ASD) and those without ASD. Importantly, this scale could identify autistic symptoms or traits distributed continually across the child population at this age irrespective of the presence of an ASD diagnosis. These findings suggest that the SRS‐P might be a sensitive instrument for case identification including subthreshold ASD, as well as a potentially useful research tool for exploring ASD endophenotypes. Autism Res 2017, 10: 852–865. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

Uniqueness of action monitoring in children with autism spectrum disorder: Response types and temporal aspects

BACKGROUND

Action monitoring, the process for evaluating the appropriateness of one's own actions, is reported to be atypical in individuals with autism spectrum disorder (ASD).

METHOD

We examined the characteristics of action monitoring in 11 children with ASD and 12 children with typical development (TD), analyzing stimulus-locked and response-locked event-related potential components (i.e., N2; error-related negativity, ERN; and error positivity, Pe) related to execution of a flanker task.

RESULTS

We found a smaller N2 amplitude in children with ASD than in those with TD. Children with ASD also had a larger amplitude of ERN for partial error responses (electromyographic activity corresponding to the inappropriate hand side before response execution) than did children with TD. Additionally, the ERN amplitude for the partial error response was correlated with the Autistic Mannerisms of the Social Responsiveness Scale. There were no significant differences in Pe amplitudes between children with ASD and those with TD.

CONCLUSION

The results suggest that action monitoring in children with ASD is significantly different both before and after response execution. We hypothesized that the detail-focused processing style of ASD reduces the demands of action monitoring before response execution; however, autistic mannerisms evoke excessive concern regarding trivial mistakes after response execution.

Disease Burden and Symptom Structure of Autism in Neurofibromatosis Type 1: A Study of the International NF1-ASD Consortium Team (INFACT)

IMPORTANCE

Recent reports have demonstrated a higher incidence of autism spectrum disorder (ASD) and substantially elevated autistic trait burden in individuals with neurofibromatosis type 1 (NF1). However, important discrepancies regarding the distribution of autistic traits, sex predominance, and association between ASD symptoms and attentional problems have emerged, and critical features of the ASD phenotype within NF1 have never been adequately explored. Establishing NF1 as a monogenic cause for ASD has important implications for affected patients and for future research focused on establishing convergent pathogenic mechanisms relevant to the potential treatment targets for ASD.

OBJECTIVE

To characterize the quantitative autistic trait (QAT) burden in a pooled NF1 data set.

DESIGN, SETTING, AND PARTICIPANTS

Anonymized, individual-level primary data were accumulated from 6 tertiary referral centers in the United States, Belgium, United Kingdom, and Australia. A total of 531 individuals recruited from NF1 clinical centers were included in the study.

MAIN OUTCOMES AND MEASURES

Distribution of ASD traits (Social Responsiveness Scale, second edition [SRS-2], with T scores of ≥75 associated with a categorical ASD diagnosis); attention-deficit/hyperactivity disorder (ADHD) traits (4 versions of Conners Rating Scale, with T scores of ≥65 indicating clinically significant ADHD symptoms); ASD symptom structure, latent structure, base rate derived from mixture modeling; and familiality.

RESULTS

Of the 531 patients included in the analysis, 247 were male (46.5%); median age was 11 years (range, 2.5-83.9 years). QAT scores were continuously distributed and pathologically shifted; 13.2% (95% CI, 10.3%-16.1%) of individuals scored within the most severe range (ie, above the first percentile of the general population distribution) in which the male to female ratio was markedly attenuated (1.6:1) relative to idiopathic ASD. Autistic symptoms in this NF1 cohort demonstrated a robust unitary factor structure, with the first principal component explaining 30.9% of the variance in SRS-2 scores, and a strong association with ADHD symptoms (r = 0.61). Within-family correlation for QAT burden (intraclass correlation coefficient, 0.73 in NF1-affected first-degree relatives) exceeded that observed in the general population and ASD family samples.

CONCLUSIONS AND RELEVANCE

This study provides confirmation that the diversity of mutations that give rise to NF1 function as quantitative trait loci for ASD. Moreover, the within-family correlation implicates a high degree of mutational specificity for this associated phenotype. Clinicians should be alerted to the increased frequency of this disabling comorbidity, and the scientific community should be aware of the potential for this monogenic disorder to help elucidate the biological features of idiopathic autism.

A hybrid concept analysis of children of concern: Japanese healthcare professionals' views of children at a high risk of developmental disability

BACKGROUND

The new Diagnostic and Statistical Manual of Mental Disorders (fifth edition, DSM-5) redefined the boundaries of autism as a spectrum. It has been reported that the number of schoolchildren with undiagnosed developmental disorders (DDs) has risen in Japan. Such children referred to as kininaru-kodomo (KK, "children of concern") by healthcare professionals fall into a gray area. Therefore, KK are often overlooked at infant medical checkups. This leaves KK without necessary medical care and special needs education. It is urgent to explore the KK concept to enable professionals to properly assess and provide for the healthcare needs of these children at a high risk of DD, ideally with early intervention.

METHODS

A hybrid model of concept analysis was conducted. Working definitions were obtained from a systematic literature review in the theoretical phase. Subsequent in-depth personal interviews initiated in the fieldwork phase corroborated and refined the concept. These qualitative data were integrated in the final analytical phase to yield the practice-based real definition of KK in clinical settings.

RESULTS

Three themes emerged regarding KK children: children who require special care, children whose special healthcare needs are owing to both individual and environmental factors, and children waiting for the development of a new support system for them or their parents.

CONCLUSIONS

This study implies that KK are children who require special support because of individual and environmental factors. The concept of KK is considered useful for keeping children with undiagnosed DDs and/or other healthcare needs connected with support networks. It is strongly recommended that a screening tool be developed that reflects the concept of children at a high risk of DD so that children in this gray area may receive necessary support even before diagnosis.

Mu rhythm suppression reflects mother-child face-to-face interactions: a pilot study with simultaneous MEG recording

Spontaneous face-to-face interactions between mothers and their children play crucial roles in the development of social minds; however, these inter-brain dynamics are still unclear. In this pilot study, we measured MEG mu suppression during face-to-face spontaneous non-linguistic interactions between mothers and their children with autism spectrum disorder (ASD) using the MEG hyperscanning system (i.e., simultaneous recording). The results demonstrated significant correlations between the index of mu suppression (IMS) in the right precentral area and the traits (or severity) of ASD in 13 mothers and 8 children (MEG data from 5 of the children could not be obtained due to motion noise). In addition, higher IMS values (i.e., strong mu suppression) in mothers were associated with higher IMS values in their children. To evaluate the behavioral contingency between mothers and their children, we calculated cross correlations between the magnitude of the mother and child head-motion during MEG recordings. As a result, in mothers whose head motions tended to follow her child's head motion, the magnitudes of mu suppression in the mother's precentral area were large. Further studies with larger sample sizes, including typically developing children, are necessary to generalize this result to typical interactions between mothers and their children.

Relationship of the Acoustic Startle Response and Its Modulation to Emotional and Behavioral Problems in Typical Development Children and Those with Autism Spectrum Disorders

Auditory hyper-reactivity is a common sensory-perceptual abnormality in autism spectrum disorders (ASD), which interrupts behavioral adaptation. We investigated acoustic startle response (ASR) modulations in 17 children with ASD and 27 with typical development (TD). Compared to TD, children with ASD had larger ASR magnitude to weak stimuli and more prolonged peak startle-latency. We could not find significant difference of prepulse inhibition (PPI) or habituation in ASD children compared to TD. However, habituation and PPI at 70-dB prepulses were negatively related to several subscales of Social Responsiveness Scale and the Strengths and Difficulties Questionnaire, when considering all children. Comprehensive investigation of ASR and its modulation might increase understanding of the neurophysiological impairments underlying ASD and other mental health problems in children.

The social responsiveness scale in relation to DSM IV and DSM5 ASD in Korean children

The Social Responsiveness Scale (SRS) is an autism rating scales in widespread use, with over 20 official foreign language translations. It has proven highly feasible for quantitative ascertainment of autistic social impairment in public health settings, however, little is known about the validity of the reinforcement in Asia populations or in references to DSM5. The current study aims to evaluate psychometric properties and cross-cultural aspects of the SRS-Korean version (K-SRS).The study subjects were ascertained from three samples: a general sample from 3 regular education elementary schools (n=790), a clinical sample (n=154) of 6-12-year-olds from four psychiatric clinics, and an epidemiological sample of children with ASD, diagnosed using both DSM IV PDD, DSM5 ASD and SCD criteria (n=151). Their parents completed the K-SRS and the Autism Spectrum Screening Questionnaire(ASSQ). Descriptive statistics, correlation analyses and principal components analysis (PCA) were performed on the total population. Mean total scores on the K-SRS differed significantly between the three samples. ASSQ scores were significantly correlated with the K-SRS T-scores. PCA suggested a one-factor solution for the total population.Our results indicate that the K-SRS exhibits adequate reliability and validity for measuring ASD symptoms in Korean children with DSM IV PDD and DSM5 ASD. Our findings further suggest that it is difficult to distinguish SCD from other child psychiatric conditions using the K-SRS.This is the first study to examine the relationship between the SRS subscales and DSM5-based clinical diagnoses. This study provides cross-cultural confirmation of the factor structure for ASD symptoms and traits measured by the SRS. Autism Res 2016, 9: 970-980. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Current viewpoints on DSM-5 in Japan

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) was published in 2013, and its official Japanese version was published in 2014. The Japanese Government uses classifications from the 10th revision of the I nternational C lassification of D iseases (ICD-10) to categorize disorders and determine treatment fees. However, since the publication of the DSM-III, the use of the DSM system has become prevalent in research and educational settings in Japan. In addition to traditional psychiatry, both the ICD and the DSM are taught by many Japanese medical schools, and virtually all clinical research and trials refer to the DSM to define targeted disorders. Amid the current backdrop in which the reputation of the DSM-5 is being established, the editorial board of P sychiatry and C linical N eurosciences has asked Japanese experts across 12 specialties to examine the structure of the DSM-5, including the following categories: Neurodevelopmental Disorders, Schizophrenia Spectrum Disorders, Major Depression, Bipolar Disorders, Obsessive-Compulsive Disorders, Somatic Symptom Disorder, Eating Disorders, Substance-Related and Addictive Disorders, Gender Dysphoria, and Neurocognitive Disorders. Although opinions were only obtained from these selected experts, we believe that we have succeeded, to a certain extent, in presenting views that are representative of each specialty.

Whether the Autism Spectrum Quotient consists of two different subgroups? Cluster analysis of the Autism Spectrum Quotient in general population

The purpose of this study was to investigate whether the individuals in the general population with high scores on the Autism Spectrum Quotient constituted a single homogeneous group or not. A cohort of university students (n = 4901) was investigated by cluster analysis based on the original five subscales of the Autism Spectrum Quotient. Based on the results of the analysis, the students could be divided into six clusters: the first with low scores on all the five subscales, the second with high scores on only the ‘attention to detail’ subscale, the third and fourth with intermediate scores on all the subscales, the fifth with high scores on four of the five subscales but low scores on the ‘attention to detail’ subscale and the sixth with high scores on all the five subscales. The students with high total Autism Spectrum Quotient scores (n = 166) were divided into two groups: one with high scores on four subscales but low scores on the ‘attention to detail’ subscale and the other with high scores on all the five subscales. The results of this study suggested that individuals from the general population with high Autism Spectrum Quotient scores may consist of two qualitatively different groups.

The Macaque Social Responsiveness Scale (mSRS): A Rapid Screening Tool for Assessing Variability in the Social Responsiveness of Rhesus Monkeys (Macaca mulatta)

Understanding the biological mechanisms underlying human neuropsychiatric disorders, such as autism spectrum disorder (ASD), has been hindered by the lack of a robust, translational animal model. Rhesus monkeys (Macaca mulatta) display many of the same social behaviors that are affected in ASD, making them an excellent animal species in which to model social impairments. However, the social impairments associated with ASD may reflect extreme ends of a continuous distribution of traits. Thus, to validate the rhesus monkey as an animal model for studying social impairments that has strong translational relevance for ASD, researchers need an easily-implemented measurement tool that can quantify variation in social behavior dimensionally. The Social Responsiveness Scale (SRS) is a 65-item survey that identifies both typical and atypical social behaviors in humans that covary with ASD symptom severity. A chimpanzee SRS has already been validated and the current study adapted this tool for use in the rhesus monkey (mSRS). Fifteen raters completed the mSRS for 105 rhesus monkeys living at the Yerkes National Primate Research Center. The mSRS scores showed a unimodal distribution with a positive skew that identified 6 statistical outliers. Inter-rater reliability was very strong, but only 17 of the 36 questions showed positive intra-item reliability. The results of an exploratory factor analysis identified 3 factors that explained over 60% of the variance, with 12 items significantly loading onto the primary factor. These items reflected behaviors associated with social avoidance, social anxiety or inflexibility and social confidence. These initial findings are encouraging and suggest that variability in the social responsiveness of rhesus monkeys can be quantified using the mSRS: a tool that has strong translational relevance for human disorders. With further modification, the mSRS may provide an promising new direction for research on the biological mechanisms underlying social impairments.

The Screening Accuracy of the Parent and Teacher-Reported Social Responsiveness Scale (SRS): Comparison with the 3Di and ADOS

The screening accuracy of the parent and teacher-reported Social Responsiveness Scale (SRS) was compared with an autism spectrum disorder (ASD) classification according to (1) the Developmental, Dimensional, and Diagnostic Interview (3 Di), (2) the Autism Diagnostic Observation Schedule (ADOS), (3) both the 3 Di and ADOS, in 186 children referred to six mental health centers. The parent report showed excellent correspondence to an ASD classification according to the 3 Di and both the 3 Di and ADOS. The teacher report added significantly to the screening accuracy over and above the parent report when compared with the ADOS classification. Findings support the screening utility of the parent-reported SRS among clinically referred children and indicate that different informants may provide unique information relevant for ASD assessment.

Propriedades psicométricas da Escala de Responsividade Social-2 para Transtornos do Espectro Autista

Objetivo O objetivo deste trabalho foi avaliar as propriedades psicométricas da versão em português da Escala de Responsividade Social-2 (ERS-2) para crianças e adolescentes com transtorno do espectro autista (TEA). Métodos A ERS-2 foi respondida pelos pais de 90 pacientes com TEA e 25 controles saudáveis. Análises quanto à validade discriminante, índices de confiabilidade e separação, de adequação e calibração dos itens pelo modelo Rasch foram realizadas. Resultados A ERS-2 demonstrou boa consistência interna (alfa de Cronbach = 0,952), um ponto de corte de 41, sensibilidade de 96,8%, especificidade de 100% e valor preditivo negativo de 99,9% para a identificação de TEA. As subescalas apresentaram, de forma geral, adequação ao modelo. No entanto, alguns itens se apresentaram pouco consistentes do ponto de vista estatístico (correlação item-total negativas e misfitting). O mapa de itens mostrou má cobertura da variável latente, especialmente no espectro mais leve do TEA. Conclusão Os resultados deste estudo mostraram que a versão em português da ERS-2 pode ser utilizada como ferramenta de triagem para o reconhecimento de TEA em crianças e adolescentes brasileiros. A escala pode ter versões futuras aprimoradas com a substituição dos itens com pior desempenho.

Changes in autistic trait indicators in parents and their children with ASD: A preliminary longitudinal study

This study investigated whether the longitudinal changes in symptom severity in children with autism spectrum disorder (ASD) are associated with changes in the parents׳ autistic traits. The results demonstrated two significant correlations between the changes in children׳s Social Responsiveness Scale (SRS) scores and the Social Responsiveness Scale (SRS) score changes in either the father or both parents. Autistic symptom mitigation in ASD children was associated with increased empathy levels in their parents.

Treatment Resistant Epilepsy in Autism Spectrum Disorder: Increased Risk for Females

The male:female ratio in autism spectrum disorder (ASD) averages greater than 4:1 while the male:female ratio of ASD with epilepsy averages less than 3:1. This indicates an elevated risk of epilepsy in females with ASD; yet, it is unknown whether phenotypic features of epilepsy and ASD differ between males and females with this comorbidity. The goal of this study is to investigate sex differences in phenotypic features of epilepsy and ASD in a prospective sample of 130 children and young adults with an initial ASD diagnosis and subsequent epilepsy diagnosis. All participants were characterized by standardized diagnostic inventories, parent/caregiver completed questionnaires, and medical/academic record review. Diagnostic classifications of epilepsy, ASD, and intellectual disability were performed by board certified neurologists and a pediatric neuropsychologist. Results demonstrated a lower male:female ratio (1.8:1) in individuals with ASD and treatment-resistant epilepsy relative to those with ASD and treatment-responsive epilepsy (4.9:1), indicating a higher risk of treatment-resistant epilepsy in females. Mild neuroimaging abnormalities were more common in females than males and this was associated with increased risk of treatment-resistance. In contrast, ASD symptom severity was lower in females compared with males. Findings distinguish females with ASD and epilepsy as a distinct subgroup at higher risk for a more severe epilepsy phenotype in the context of a less severe ASD phenotype. Increased risk of anti-epileptic treatment resistance in females with ASD and epilepsy suggests that comprehensive genetic, imaging, and neurologic screening and enhanced treatment monitoring may be indicated for this subgroup. Autism Res 2016, 9: 311-320. © 2015 International Society for Autism Research, Wiley Periodicals, Inc.

The female protective effect in autism spectrum disorder is not mediated by a single genetic locus

BACKGROUND

A 4:1 male to female sex bias has consistently been observed in autism spectrum disorder (ASD). Epidemiological and genetic studies suggest a female protective effect (FPE) may account for part of this bias; however, the mechanism of such protection is unknown. Quantitative assessment of ASD symptoms using the Social Responsiveness Scale (SRS) shows a bimodal distribution unique to females in multiplex families. This leads to the hypothesis that a single, common genetic locus on chromosome X might mediate the FPE and produce the ASD sex bias. Such a locus would represent a major therapeutic target and is likely to have been missed by conventional genome-wide association study (GWAS) analysis.

METHODS

To explore this possibility, we performed an association study in affected versus unaffected females, considering three tiers of single nucleotide polymorphisms (SNPs) as follows: 1) regions of chromosome X that escape X-inactivation, 2) all of chromosome X, and 3) genome-wide.

RESULTS

No evidence of a SNP meeting the criteria for a single FPE locus was observed, despite the analysis being well powered to detect this effect.

CONCLUSIONS

The results do not support the hypothesis that the FPE is mediated by a single genetic locus; however, this does not exclude the possibility of multiple genetic loci playing a role in the FPE.

Autistic-like traits in adult patients with mood disorders and schizophrenia

Autism spectrum disorder often co-occurs with other psychiatric disorders. Although a high prevalence of autistic-like traits/symptoms has been identified in the pediatric psychiatric population of normal intelligence, there are no reports from adult psychiatric population. This study examined whether there is a greater prevalence of autistic-like traits/symptoms in patients with adult-onset psychiatric disorders such as major depressive disorder (MDD), bipolar disorder, or schizophrenia, and whether such an association is independent of symptom severity. The subjects were 290 adults of normal intelligence between 25 and 59 years of age (MDD, n=125; bipolar disorder, n=56; schizophrenia, n=44; healthy controls, n=65). Autistic-like traits/symptoms were measured using the Social Responsiveness Scale for Adults. Symptom severity was measured using the Positive and Negative Symptoms Scale, the Hamilton Depression Rating Scale, and/or the Young Mania Rating Scale. Almost half of the clinical subjects, except those with remitted MDD, exhibited autistic-like traits/symptoms at levels typical for sub-threshold or threshold autism spectrum disorder. Furthermore, the proportion of psychiatric patients that demonstrated high autistic-like traits/symptoms was significantly greater than that of healthy controls, and not different between that of remitted or unremitted subjects with bipolar disorder or schizophrenia. On the other hand, remitted subjects with MDD did not differ from healthy controls with regard to the prevalence or degree of high autistic-like traits/symptoms. A substantial proportion of adults with bipolar disorder and schizophrenia showed high autistic-like traits/symptoms independent of symptom severity, suggesting a shared pathophysiology among autism spectrum disorder and these psychiatric disorders. Conversely, autistic-like traits among subjects with MDD were associated with the depressive symptom severity. These findings suggest the importance of evaluating autistic-like traits/symptoms underlying adult-onset psychiatric disorders for the best-suited treatment. Further studies with a prospective design and larger samples are needed.

Broader autism phenotype in mothers predicts social responsiveness in young children with autism spectrum disorders

AIMS

The aim of this study was to identify phenotypes in mothers and fathers that are specifically associated with disturbances in reciprocal social interactions and communication in their young children with autism spectrum disorder (ASD) in a Japanese sample.

METHODS

Autistic traits in parents were evaluated using the Autism-spectrum Quotient (AQ), the Empathy Quotient (EQ) and the Systemizing Quotient (SQ) in 88 parents (44 mothers and corresponding fathers) of children with ASD and in 60 parents (30 mothers and corresponding fathers) of typically developing (TD) children. For the measurement of autistic traits in children, we employed the Social Responsiveness Scale (SRS).

RESULTS

In two of the five AQ subscales (social skills and communication), the parents of ASD children scored significantly higher than did the parents of TD children, regardless of whether the parent was a mother or a father. In addition, in mothers of ASD children, there were significant positive correlations between two of the five AQ subscales (attention-switching and communication) and the SRS T-score in their children.

CONCLUSIONS

This is the first study to demonstrate that the social skills and communication subscales in the AQ are more sensitive as autism traits in a Japanese sample and to demonstrate that some autistic traits in mothers are specifically associated with disturbances in the social ability of their young children with ASD, as measured by the SRS score. Further study is necessary to determine whether these results were caused by genetic or environmental factors.

Familiality of Quantitative Autism Traits

Background:

Autistic traits exist along a continuum that extends into social functioning in the general population, and they aggregate in the family members of children with autism spectrum disorder (ASD). Quantitative measures are therefore essential when investigating the patterns of familiality of these traits. Prior studies have suggested differential inheritance patterns of autistic traits that depend on the cognitive level of the child with ASD as well as the family type.

Objective:

Our goal was to examine the family patterns of quantitative autism traits (QAT) in a group of simplex autism families of high-functioning children with ASD.

Method:

We used the Social Responsiveness Scale (SRS) to evaluate QAT in 47 ASD families and 46 control families. SRS assessments (parental/spousal evaluations) were collected for the children with ASD, their siblings, and their parents as well as for the control children and their parents.

Results:

The SRS was able to distinguish individuals with ASD from the control children and from their unaffected siblings. Significant group differences were also found when comparing the fathers of ASD families to control fathers and when comparing the brothers of individuals with ASD to control boys, with male members of ASD families having higher SRS scores. Gender differences were observed in the group of siblings of children with ASD and the group of parents of children with ASD, with males having higher scores than females. In ASD families, a positive trend between child and father QAT was found, whereas mothers’ scores were not associated with child outcomes. By contrast, in control families, mothers’ QAT correlated more strongly with child QAT.

Conclusions:

Autistic traits aggregate in the fathers and brothers of children with ASD in simplex autism families. The QAT levels of the family members should be taken into consideration when planning the rehabilitation of the child or adolescent with ASD and when designing family interventions.

ADHD symptoms, autistic traits, and substance use and misuse in adult Australian twins

OBJECTIVE

Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder frequently co-occur. Several studies show increased risk of substance use disorders in ADHD, yet there is limited information related to how ADHD symptoms, autistic traits, and their combined effects are associated with nicotine, alcohol, and cannabis use and use disorders in the general population.

METHOD

Cross-sectional interview and self-report questionnaire data from 3,080 young adult Australian twins (mean age 31.9 years) were used to assess ADHD symptoms, autistic traits, substance use, and substance use disorders. Substance use disorders-based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria-were assessed in the full sample as well as in those who reported substance use. Logistic regression analyses were used for comparing the associations between ADHD symptoms, autistic traits, substance use, and substance misuse after conduct disorder, sex, age, and zygosity were controlled for.

RESULTS

Greater ADHD symptoms and autistic traits scores were associated with elevated levels of regular smoking; cannabis use; and nicotine, alcohol, and cannabis use disorders, even after conduct disorder was adjusted for. In contrast, for alcohol use, those with high autistic traits scores were less likely to report drinking to intoxication. However, upon initiation, and similar to the findings for nicotine and cannabis, they were at elevated risk for developing alcohol dependence.

CONCLUSIONS

Increased liability to ADHD and elevated autistic traits scores were associated with substance use and misuse, with the exception of alcohol use. Given the social underpinnings of drinking, persons with autistic traits may be less likely to engage in it; however, upon engagement in drinking, their vulnerability to alcohol dependence is elevated.

Verification of the utility of the social responsiveness scale for adults in non-clinical and clinical adult populations in Japan

BACKGROUND

Recently great attention has been paid to the still unmet clinical needs of most adults with autism spectrum disorder (ASD) who live in the community, an increasing number of whom visit psychiatric clinics to seek accurate diagnosis and treatment of concurrent psychiatric symptoms. However, different from the case of children diagnosed with ASD in childhood, it is difficult in adults to identify the ASD symptoms underlying psychopathology and to differentiate ASD from other psychiatric disorders in general psychiatric practice. This study aimed to verify the utility of the Social Responsiveness Scale-Adult version (SRS-A), a quantitative measure for identifying ASD symptoms, in non-clinical and clinical adult populations in Japan.

METHODS

The total sample aged 19 to 59 years consisted of a non-clinical population (n =592) and clinical population with and without ASD (n =142). We examined score distributions of the Japanese version of the scale, and the effects of gender, age, and rater on the distribution. We analyzed factor structure and internal consistency in the non-clinical normative sample, and analyzed convergent, divergent, and discriminative validities in the clinical sample. We applied receiver operator characteristic (ROC) analysis to determine optimal cutoff scores discriminating the ASD clinical population from the non-ASD clinical population.

RESULTS

The score distributed continuously, which replicated findings in children. For non-clinical adults, except in men aged 19 to 24 years, we found no or few gender, age, or rater effects. Both single- and two-factor models were supported for adults. Total SRS-A scores demonstrated high internal consistency and capably discriminated adults with ASD from those with non-ASD psychiatric disorders such as major depressive disorder, schizophrenia, and bipolar disorder with an overlap across diagnoses. Moderate to high correlations of the SRS-A with other-rated ASD measures indicated sufficient convergent validity. Based on the ROC analysis, we recommend cutoff points by gender for use in clinical settings.

CONCLUSION

This study provides additional supportive evidence that the Japanese version SRS-A can reliably and validly measure ASD symptoms in non-clinical and clinical adult populations, and thus can serve as a useful tool for ASD research as well as for secondary screening in Japanese adults.

Autistic empathy toward autistic others

Individuals with autism spectrum disorder (ASD) are thought to lack self-awareness and to experience difficulty empathizing with others. Although these deficits have been demonstrated in previous studies, most of the target stimuli were constructed for typically developing (TD) individuals. We employed judgment tasks capable of indexing self-relevant processing in individuals with and without ASD. Fourteen Japanese men and 1 Japanese women with high-functioning ASD (17–41 years of age) and 13 Japanese men and 2 TD Japanese women (22–40 years of age), all of whom were matched for age and full and verbal intelligence quotient scores with the ASD participants, were enrolled in this study. The results demonstrated that the ventromedial prefrontal cortex was significantly activated in individuals with ASD in response to autistic characters and in TD individuals in response to non-autistic characters. Although the frontal–posterior network between the ventromedial prefrontal cortex and superior temporal gyrus participated in the processing of non-autistic characters in TD individuals, an alternative network was involved when individuals with ASD processed autistic characters. This suggests an atypical form of empathy in individuals with ASD toward others with ASD.

Hyperreactivity to weak acoustic stimuli and prolonged acoustic startle latency in children with autism spectrum disorders

BACKGROUND

People with autism spectrum disorders (ASD) are known to have enhanced auditory perception, however, acoustic startle response to weak stimuli has not been well documented in this population. The objectives of this study are to evaluate the basic profile of acoustic startle response, including peak startle latency and startle magnitude to weaker stimuli, in children with ASD and typical development (TD), and to evaluate their relationship to ASD characteristics.

METHODS

We investigated acoustic startle response with weak and strong acoustic stimuli in 12 children with ASD and 28 children with TD, analyzing the relationship between startle measures and quantitative autistic traits assessed with the Social Responsiveness Scale (SRS). The electromyographic activity of the left orbicularis oculi muscle to acoustic stimuli of 65 to 115 dB sound pressure level (SPL), in increments of 5 dB, was measured to evaluate acoustic startle response. The average eyeblink magnitude for each acoustic stimuli intensity and the average peak startle latency of acoustic startle response were evaluated.

RESULTS

The magnitude of the acoustic startle response to weak stimuli (85 dB or smaller) was greater in children with ASD. The peak startle latency was also prolonged in individuals with ASD. The average magnitude of the acoustic startle response for stimulus intensities greater than 85 dB was not significantly larger in the ASD group compared with the controls. Both greater startle magnitude in response to weak stimuli (particularly at 85 dB) and prolonged peak startle latency were significantly associated with total scores, as well as several subscales of the SRS in the whole sample. We also found a significant relationship between scores on the social cognition subscale of the SRS and the average magnitude of the acoustic startle response for stimulus intensities of 80 and 85 dB in the TD group.

CONCLUSIONS

Children with ASD exhibited larger startle magnitude to weak stimuli and prolonged peak startle latency. These startle indices were related to several characteristics of ASD. A comprehensive investigation of acoustic startle response, including the magnitude of startle responses to weak stimuli and peak startle latency, might further our understanding of the neurophysiological impairments underlying ASD.