Gray matter asymmetry alterations in children and adolescents with comorbid autism spectrum disorder and attention-deficit/hyperactivity disorder

Effective connectivity alterations of the triple network model in the co-occurrence of autism spectrum disorder and attention deficit hyperactivity disorder

Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) are both highly prevalent disorders and frequently co-occur. The underlying neurological mechanisms of the co-occurrence of ASD and ADHD (ASD + ADHD) remain unknown. This study focuses on investigating the effective connectivity (EC) alterations within the triple network model in individuals with ASD + ADHD. Resting-state functional magnetic resonance imaging data were obtained from 44 individuals with ASD + ADHD, 60 individuals with ASD without ADHD (ASD-only), 35 individuals with ADHD without ASD (ADHD-only), and 81 healthy controls (HC) from the Autism Brain Imaging Data Exchange II and the ADHD-200 Sample database. Spectral dynamic causal modeling was employed to explore the EC alterations within and between the default mode network, salience network, and central executive network. Our analysis showed that compared to HC, ASD + ADHD, ASD-only, and ADHD-only exhibited both shared and disorder-specific EC alterations within the triple-network model. These results have potential clinical implications for identifying ASD + ADHD, facilitating diagnostic accuracy, guiding targeted treatment approaches, and informing etiological studies.

Autism Spectrum Disorder: Brain Areas Involved, Neurobiological Mechanisms, Diagnoses and Therapies

Autism spectrum disorder (ASD), affecting over 2% of the pre-school children population, includes an important fraction of the conditions accounting for the heterogeneity of autism. The disease was discovered 75 years ago, and the present review, based on critical evaluations of the recognized ASD studies from the beginning of 1990, has been further developed by the comparative analyses of the research and clinical reports, which have grown progressively in recent years up to late 2023. The tools necessary for the identification of the ASD disease and its related clinical pathologies are genetic and epigenetic mutations affected by the specific interaction with transcription factors and chromatin remodeling processes occurring within specific complexes of brain neurons. Most often, the ensuing effects induce the inhibition/excitation of synaptic structures sustained primarily, at dendritic fibers, by alterations of flat and spine response sites. These effects are relevant because synapses, established by specific interactions of neurons with glial cells, operate as early and key targets of ASD. The pathology of children is often suspected by parents and communities and then confirmed by ensuing experiences. The final diagnoses of children and mature patients are then completed by the combination of neuropsychological (cognitive) tests and electro-/magneto-encephalography studies developed in specialized centers. ASD comorbidities, induced by processes such as anxieties, depressions, hyperactivities, and sleep defects, interact with and reinforce other brain diseases, especially schizophrenia. Advanced therapies, prescribed to children and adult patients for the control of ASD symptoms and disease, are based on the combination of well-known brain drugs with classical tools of neurologic and psychiatric practice. Overall, this review reports and discusses the advanced knowledge about the biological and medical properties of ASD.