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Allely CS, Jouenne E, Westphal A, Staufenberg E, Murphy D. Autism spectrum disorder, extremism and risk assessment. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024; 34:182-196. [PMID: 38341798 DOI: 10.1002/cbm.2330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 01/04/2024] [Indexed: 02/13/2024]
Abstract
BACKGROUND To date, there is no evidence supporting the existence of an association between Autism Spectrum Disorder (ASD) and extremism in the general population. However, there is increasing recognition that several features of ASD may provide the context of vulnerability to engage in extremist behaviour. AIMS This paper sets out the case for a dedicated clinical approach to better integrate clinical risk appraisal processes with an assessment of ASD individuals' vulnerabilities within the Criminal Justice System. METHODS AND RESULTS In this paper the Framework for the Assessment of Risk & Protection in Offenders on the Autistic Spectrum (FARAS): A Guide for Risk Assessors Working with Offenders on the Autistic Spectrum is explored. In developing the FARAS, Al-Attar proposed seven facets of ASD that 'may have different functional links with push and pull factors to terrorism' (p. 928), which include circumscribed interests; rich vivid fantasy and impaired social imagination; need for order, rules, rituals, routine and predictability; obsessionality, repetition and collecting; social interaction and communication difficulties; cognitive styles and Sensory processing. DISCUSSION AND CONCLUSION We describe the FARAS within the context of the most widely used clinical risk appraisal 'aide memoire' instruments integral to the Structured Professional Judgement of risk process, namely the HCR20v3.
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Affiliation(s)
| | - Emma Jouenne
- Independent Expert, Radicalisation and Extremism, Washington, District of Columbia, USA
| | - Alexander Westphal
- Division of Law and Psychiatry, Department of Psychiatry, Yale School of Medicine (Primary), New Haven, Connecticut, USA
- Yale Child Study Center (Secondary), New Haven, Connecticut, USA
| | | | - David Murphy
- Broadmoor Hospital, West London Health Trust, Crowthorne, UK
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2
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Maguire K, Warman H, Blumenfeld F, Langdon PE. The relationship between psychopathy and autism: a systematic review and narrative synthesis. Front Psychiatry 2024; 15:1375170. [PMID: 38600985 PMCID: PMC11004474 DOI: 10.3389/fpsyt.2024.1375170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/13/2024] [Indexed: 04/12/2024] Open
Abstract
Background and methods The aim of this systematic review was to synthesise research examining the relationship between autism and psychopathy to: (a) better understand the relationship between these two constructs, and (b) describe the clinical manifestation of the two when they co-occur. A systematic search of the literature returned 36 studies. Results Across all ages, autistic individuals and those with elevated autistic traits but no autistic diagnoses appeared to have increased callous and unemotional traits or psychopathy relative to the general population. Several studies evidenced that although both constructs are associated with empathetic dysfunction, the underlying mechanisms differ. In adults, psychopathy/psychopathic traits were associated with diminished affective empathy and intact cognitive empathy, whilst the opposite was seen autistic adults and those with elevated autistic traits. In children, those with autistic traits or a diagnosis of autism had diminished cognitive empathy, but not affective empathy, while the relationship between callous and unemotional traits/psychopathy and empathy amongst children was less clear. The co-occurrence of autism and psychopathy was seen to lead to additional empathic and cognitive impairment, but findings were mixed making it challenging to clearly describe the clinical manifestation. Conclusion There remains a paucity of research investigating the interaction between autism and psychopathy and included studies were characterised by multiple measurement difficulties. Attention should be directed toward developing better methods for identifying psychopathic traits in autistic individuals to advance our understanding of the relationship between autism and psychopathy to allow for the development of appropriate care pathways for this population. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=413672, identifier CRD42023413672.
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Affiliation(s)
- Kate Maguire
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Hayley Warman
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Frances Blumenfeld
- School of Health and Social Care, University of Essex, Colchester, United Kingdom
| | - Peter E. Langdon
- Centre for Research in Intellectual and Developmental Disabilities (CIDD), University of Warwick, Coventry, United Kingdom
- Coventry and Warwickshire Partnership National Health Service (NHS) Trust, Coventry, United Kingdom
- Worcestershire Health and Care National Health Service (NHS) Trust, Worcester, United Kingdom
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3
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Lei J, Charman T, Leigh E, Russell A, Mohamed Z, Hollocks MJ. Examining the relationship between cognitive inflexibility and internalizing and externalizing symptoms in autistic children and adolescents: A systematic review and meta-analysis. Autism Res 2022; 15:2265-2295. [PMID: 36196666 PMCID: PMC10092776 DOI: 10.1002/aur.2826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 09/19/2022] [Indexed: 12/15/2022]
Abstract
Compared to neurotypical peers, autistic adolescents show greater cognitive inflexibility (CI) which manifests at the behavioral and cognitive level and potentially increases vulnerability for the development of internalizing (INT) and externalizing (EXT) symptoms. This systematic review and meta-analysis explored the association between CI and INT/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (n = 1608) of CI and INT, and 15 studies (n = 1115) of CI and EXT. A pooled effect size using Pearson's correlation between CI and INT/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta-regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co-occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; n = 833; r = 0.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; n = 295; r = 0.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co-occurring ADHD. Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co-occurring mental health difficulties.
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Affiliation(s)
- Jiedi Lei
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Tony Charman
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, UK
| | - Zameer Mohamed
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Matthew J Hollocks
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Trust, London, UK
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Psychopathic and autistic traits differentially influence the neural mechanisms of social cognition from communication signals. Transl Psychiatry 2022; 12:494. [PMID: 36446775 PMCID: PMC9709037 DOI: 10.1038/s41398-022-02260-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 12/02/2022] Open
Abstract
Psychopathy is associated with severe deviations in social behavior and cognition. While previous research described such cognitive and neural alterations in the processing of rather specific social information from human expressions, some open questions remain concerning central and differential neurocognitive deficits underlying psychopathic behavior. Here we investigated three rather unexplored factors to explain these deficits, first, by assessing psychopathy subtypes in social cognition, second, by investigating the discrimination of social communication sounds (speech, non-speech) from other non-social sounds, and third, by determining the neural overlap in social cognition impairments with autistic traits, given potential common deficits in the processing of communicative voice signals. The study was exploratory with a focus on how psychopathic and autistic traits differentially influence the function of social cognitive and affective brain networks in response to social voice stimuli. We used a parametric data analysis approach from a sample of 113 participants (47 male, 66 female) with ages ranging between 18 and 40 years (mean 25.59, SD 4.79). Our data revealed four important findings. First, we found a phenotypical overlap between secondary but not primary psychopathy with autistic traits. Second, primary psychopathy showed various neural deficits in neural voice processing nodes (speech, non-speech voices) and in brain systems for social cognition (mirroring, mentalizing, empathy, emotional contagion). Primary psychopathy also showed deficits in the basal ganglia (BG) system that seems specific to the social decoding of communicative voice signals. Third, neural deviations in secondary psychopathy were restricted to social mirroring and mentalizing impairments, but with additional and so far undescribed deficits at the level of auditory sensory processing, potentially concerning deficits in ventral auditory stream mechanisms (auditory object identification). Fourth, high autistic traits also revealed neural deviations in sensory cortices, but rather in the dorsal auditory processing streams (communicative context encoding). Taken together, social cognition of voice signals shows considerable deviations in psychopathy, with differential and newly described deficits in the BG system in primary psychopathy and at the neural level of sensory processing in secondary psychopathy. These deficits seem especially triggered during the social cognition from vocal communication signals.
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Woodbury-Smith MR, Loftin R, Westphal A, Volkmar FR. Vulnerability to Ideologically-Motivated Violence Among Individuals With Autism Spectrum Disorder. Front Psychiatry 2022; 13:873121. [PMID: 35401260 PMCID: PMC8990964 DOI: 10.3389/fpsyt.2022.873121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/04/2022] [Indexed: 11/13/2022] Open
Abstract
People with autism spectrum disorder (ASD) are represented among those who espouse extremist thought and have committed violent acts associated with their beliefs. Media often highlight a perpetrator's psychiatric diagnosis following acts of mass violence, which in some instances has included ASD. ASD may itself not provide useful information for understanding motivations. Instead, understanding specific traits and neuropsychological and other vulnerabilities may offer an opportunity to make sense of these very complex events.
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Affiliation(s)
| | - Rachel Loftin
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Feinberg School of Medicine, Chicago, IL, United States
| | - Alexander Westphal
- Division of Law and Psychiatry, Department of Psychiatry and Child Study Center, Yale University, New Haven, CT, United States
| | - Fred R Volkmar
- Child Study Center, Yale University and Southern Connecticut State University, New Haven, CT, United States
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Noppari T, Sun L, Lukkarinen L, Putkinen V, Tani P, Lindberg N, Saure E, Lauerma H, Tiihonen J, Venetjoki N, Salomaa M, Rautio P, Hirvonen J, Salmi J, Nummenmaa L. Brain structural alterations in autism and criminal psychopathy. NEUROIMAGE: CLINICAL 2022; 35:103116. [PMID: 35872437 PMCID: PMC9421457 DOI: 10.1016/j.nicl.2022.103116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/28/2022] Open
Abstract
Autism and psychopathy are both disorders of social cognition and share numerous of their features but still differ distinctively in their clinical phenotype. The lower grey matter volumes in the right temporal pole and the left inferior frontal gyrus are the most prominent findings distinguishing violent offenders with high psychopatic from ASD individuals. Violent offenders with high psychopatic traits and individuals with ASD both present similar lower grey matter volumes in the right precentral cortex compared to controls.
The goal of this study was to elucidate the anatomical brain basis of social cognition through two disorders with distinctively different phenotypes of social interaction. We compared structural MR images of 20 individuals with autism spectrum disorder (ASD), 19 violent offenders with high psychopathic traits, and 19 control participants using voxel-based morphometry (VBM). Our earlier study showed lower grey matter volume (GMV) values in the insula, frontal cortex, and sensorimotor cortex of the offender group compared to controls. In the present study, the images of the ASD group revealed lower GMV in the left precuneus, right cerebellum, and right precentral gyrus in comparison with controls. The comparison between the offender and ASD groups showed lower GMV values for the right temporal pole and left inferior frontal gyrus in the offender group. There was also an overlap of both disorders in the right pre-central cortex, showing lower GMV compared to controls. Our findings suggest structural differences between violent offenders with high psychopathy traits and ASD individuals in the frontotemporal social brain network areas, previously associated with empathy. We also provide evidence of similar abnormal structures in the motor cortex for both of these disorders, possibly related to uniting issues of social cognition.
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Affiliation(s)
- Tuomo Noppari
- Turku PET Centre, University of Turku, Turku, Finland; Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland.
| | - Lihua Sun
- Turku PET Centre, University of Turku, Turku, Finland; Department of Nuclear Medicine, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Vesa Putkinen
- Turku PET Centre, University of Turku, Turku, Finland
| | - Pekka Tani
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Nina Lindberg
- Department of Forensic Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland; BABA Center and Department of Clinical Neurophysiology, Children's Hospital, Helsinki University Hospital and University of Helsinki, Finland
| | - Hannu Lauerma
- Psychiatric Hospital for Prisoners, Health Care Services for Prisoners, Turku, Finland; Department of Forensic Psychiatry, Turku University Central Hospital, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institute and Center for Psychiatry Research, Stockholm, Sweden; Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland; Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Niina Venetjoki
- Psychiatric Hospital for Prisoners, Health Care Services for Prisoners, Turku, Finland
| | - Marja Salomaa
- Psychiatric Hospital for Prisoners, Health Care Services for Prisoners, Turku, Finland
| | - Päivi Rautio
- Psychiatric Hospital for Prisoners, Health Care Services for Prisoners, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, Turku, Finland
| | - Juha Salmi
- Department of Neuroscience and Biomedical Engineering, School of Science, Aalto University, Espoo, Finland
| | - Lauri Nummenmaa
- Turku PET Centre, University of Turku, Turku, Finland; Department of Psychology, University of Turku, Turku, Finland
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7
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Wilson AC. Development and validation of the conversation questionnaire: A psychometric measure of communication challenges generated from the self-reports of autistic people. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2022; 7:23969415221123286. [PMID: 36438158 PMCID: PMC9685143 DOI: 10.1177/23969415221123286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Existing measures of communication challenges in autism are based on diagnostic criteria and research/clinical observations of autistic people, rather than what autistic people themselves identify as difficulties. In this study, the Conversation Questionnaire (CQ) was developed based on community engagement with autistic people to identify what they find challenging about conversation. This new tool was then administered online to autistic, dyslexic and neurotypical people (N = 312) in a validation phase of the study. Item-response theory modelling indicated that a two-dimensional structure accounted for response patterns. These dimensions reflected difficulties knowing what to say (15 items) and engaging in behaviours possibly disruptive to neurotypical conversation (21 items). The dimensions showed good internal consistency and convergent and discriminant validity, and could distinguish between autistic and neurotypical people (d = 1.59 and d = 2.07 respectively). The CQ might help contribute to diagnostic assessment for autism in adults as part of a holistic assessment. The questionnaire might also be useful with other neurodiverse groups, and provide a tool for clinicians and researchers to identify individuals' strengths and difficulties in conversation (e.g., as part of interventions in speech and language therapy).
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Affiliation(s)
- Alexander C Wilson
- Alexander C Wilson, Department of
Experimental Psychology, Anna Watts Building, University of Oxford, Radcliffe
Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom; Author is
now at School of Psychology, Ridley Building, Newcastle University, Newcastle
Upon Tyne, NE1 7RU, United Kingdom.
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8
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Georgiou G, Fanti KA. Physiological reactivity in children with high callous-unemotional and autistic traits: investigating unique and interactive effects. Eur Child Adolesc Psychiatry 2021; 30:1709-1722. [PMID: 32944836 DOI: 10.1007/s00787-020-01643-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
Empathy deficits are a hallmark sign of both callous-unemotional (CU) and autistic traits. Despite these similarities, prior work did not investigate how these traits relate to physiological reactivity (heart rate and skin conductance) in response to emotional or empathy-eliciting stimuli. Understanding the physiological mechanisms associated with emotional processing deficits among individuals with autistic or CU traits is a critical step for improving both assessment and interventions. The current study was designed to investigate the unique and interactive contributions of CU and autistic traits in predicting physiological reactivity. Heart rate (HR) and skin conductance (SC) activity in response to sad, fearful and happy emotional videos were collected form young children. Participants for the current study (n = 163; Mage = 7.30, SD= 1.42; 44.2% girls) were recruited from a larger community sample of 1652 children and were selected based on their levels of empathy. Regression analysis revealed that boys, but not girls, with high levels of CU traits exhibited low SC reactivity during sad and fearful stimuli. No significant associations were revealed for autistic traits. Finally, an interesting interaction effect suggested that CU traits were associated with stronger HR reactivity to fear stimuli only when autistic traits were low. The identified differences in physiological reactivity can inform etiological hypothesis by providing evidence for the underlying physiological mechanisms related to emotional processing among children high in CU traits but not in autistic traits.
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Affiliation(s)
- Giorgos Georgiou
- Department of Social and Behavioral Sciences, European University of Cyprus, P.O. Box 22006, 1516, Nicosia, Cyprus.
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Bedford R, Carter Leno V, Wright N, Bluett-Duncan M, Smith TJ, Anzures G, Pickles A, Sharp H, Hill J. Emotion Recognition Performance in Children with Callous Unemotional Traits is Modulated by Co-occurring Autistic Traits. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2021; 50:811-827. [PMID: 33252272 DOI: 10.1080/15374416.2020.1833338] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Atypical emotion recognition (ER) is characteristic of children with high callous unemotional (CU) traits. The current study aims to 1) replicate studies showing ER difficulties for static faces in relation to high CU-traits; 2) test whether ER difficulties remain when more naturalistic dynamic stimuli are used; 3) test whether ER performance for dynamic stimuli is moderated by eye-gaze direction and 4) assess the impact of co-occurring autistic traits on the association between CU and ER. METHODS Participants were 292 (152 male) 7-year-olds from the Wirral Child Health and Development Study (WCHADS). Children completed a static and dynamic ER eye-tracking task, and accuracy, reaction time and attention to the eyes were recorded. RESULTS Higher parent-reported CU-traits were significantly associated with reduced ER for static expressions, with lower accuracy for angry and happy faces. No association was found for dynamic expressions. However, parent-reported autistic traits were associated with ER difficulties for both static and dynamic expressions, and after controlling for autistic traits, the association between CU-traits and ER for static expressions became non-significant. CU-traits and looking to the eyes were not associated in either paradigm. CONCLUSION The finding that CU-traits and ER are associated for static but not naturalistic dynamic expressions may be because motion cues in the dynamic stimuli draw attention to emotion-relevant features such as eyes and mouth. Further, results suggest that ER difficulties in CU-traits may be due, in part, to co-occurring autistic traits. Future developmental studies are required to tease apart pathways toward the apparently overlapping cognitive phenotype.
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Affiliation(s)
- Rachael Bedford
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London
- Department of Psychology, University of Bath
| | - Virginia Carter Leno
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Nicola Wright
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London
- Department of Psychological Sciences, Institute of Life and Human Sciences, Liverpool University
| | - Matthew Bluett-Duncan
- Department of Psychological Sciences, Institute of Life and Human Sciences, Liverpool University
| | - Tim J Smith
- Department of Psychological Sciences, Birkbeck College, University of London
| | - Gizelle Anzures
- Department of Psychology, Florida Atlantic University
- Brain Institute, Florida Atlantic University
| | - Andrew Pickles
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Helen Sharp
- Department of Psychological Sciences, Institute of Life and Human Sciences, Liverpool University
| | - Jonathan Hill
- School of Psychology and Clinical Language Sciences, University of Reading
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Chang CL, Liu TL, Hsiao RC, Yang P, Chen YL, Yen CF. Callous-Unemotional Traits among Adolescents with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, or Typical Development: Differences between Adolescents' and Parents' Views. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083972. [PMID: 33918812 PMCID: PMC8069479 DOI: 10.3390/ijerph18083972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 11/16/2022]
Abstract
This study examined parent-adolescent agreement on the callous, uncaring, and unemotional dimensions of callous-unemotional (CU) traits and the differences in adolescent-reported and parent-reported CU traits among 126 adolescents with autism spectrum disorder (ASD), 207 adolescents with attention-deficit/hyperactivity disorder (ADHD), and 203 typically developing (TD) adolescents. Adolescent-reported and parent-reported CU traits on the three dimensions of the Inventory of Callous and Unemotional Traits were obtained. The strength of CU traits and the differences between adolescent-reported and parent-reported traits were compared among the three groups using analysis of covariance. Parent-adolescent agreement was examined using intraclass correlation. The results reveal that both adolescent-reported and parent-reported callousness and uncaring traits in the ASD and ADHD groups were significantly stronger than those in the TD group. Parent-adolescent agreement on the uncaring trait was fair across the three groups, whereas that on callousness was poor across all three groups. Parent-adolescent agreement on unemotionality was fair in the TD group but poor in the ADHD and ASD groups. ASD and ADHD groups had significantly greater differences in scores reported by parents and adolescents on the callousness trait than the TD group. The parent-adolescent score differences in the uncaring trait were also larger in the ASD group than in the TD group. Thus, these results support the application of a multi-informant approach in CU trait assessment, especially for adolescents with ASD or ADHD.
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Affiliation(s)
- Chen-Lin Chang
- Department of Psychiatry, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan;
- School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (T.-L.L.); (P.Y.)
| | - Tai-Ling Liu
- School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (T.-L.L.); (P.Y.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Ray C. Hsiao
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98195-6560, USA;
- Department of Psychiatry, Children’s Hospital and Regional Medical Center, Seattle, WA 98105, USA
| | - Pinchen Yang
- School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (T.-L.L.); (P.Y.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
| | - Yi-Lung Chen
- Department of Healthcare Administration, Asia University, Taichung 41354, Taiwan
- Department of Psychology, Asia University, Taichung 41354, Taiwan
- Correspondence: (Y.-L.C.); (C.-F.Y.); Tel.: +886-4-2332-3456 (ext. 20106) (Y.-L.C.); +886-7-312-1101 (ext. 6822) (C.-F.Y.); Fax: +886-4-2332-1206 (Y.-L.C.); +886-7-313-4761 (C.-F.Y.)
| | - Cheng-Fang Yen
- School of Medicine, and Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan; (T.-L.L.); (P.Y.)
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80708, Taiwan
- Correspondence: (Y.-L.C.); (C.-F.Y.); Tel.: +886-4-2332-3456 (ext. 20106) (Y.-L.C.); +886-7-312-1101 (ext. 6822) (C.-F.Y.); Fax: +886-4-2332-1206 (Y.-L.C.); +886-7-313-4761 (C.-F.Y.)
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11
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Rhee SH, Woodward K, Corley RP, du Pont A, Friedman NP, Hewitt JK, Hink LK, Robinson J, Zahn-Waxler C. The association between toddlerhood empathy deficits and antisocial personality disorder symptoms and psychopathy in adulthood. Dev Psychopathol 2021; 33:173-183. [PMID: 32115005 PMCID: PMC7483195 DOI: 10.1017/s0954579419001676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The present study examined empathy deficits in toddlerhood (age 14 to 36 months) as predictors of antisocial personality disorder (ASPD) symptoms and psychopathy measured by the Levenson Self-Report Psychopathy scale (Levenson, Kiehl, & Fitzpatrick, 1995) in adulthood (age 23 years) in 956 individuals from the Colorado Longitudinal Twin Study. Consistent with the hypothesis that antisocial behavior is associated with "active" rather than "passive" empathy deficits, early disregard for others, not lack of concern for others, predicted later ASPD symptoms. Early disregard for others was also significantly associated with factor 1 of the Levenson Self-Report Psychopathy Scale, which includes items assessing interpersonal and affective deficits, but not with factor 2, which includes items assessing impulsivity and poor behavioral control. The association between early disregard for others and psychopathy factor 2 was near zero after controlling for the shared variance between psychopathy factors 1 and 2. These results suggest that there is a propensity toward adulthood ASPD symptoms and psychopathy factor 1 that can be assessed early in development, which may help identify individuals most at risk for stable antisocial outcomes.
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Affiliation(s)
- Soo Hyun Rhee
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - Kerri Woodward
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - Robin P Corley
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - Alta du Pont
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - Naomi P Friedman
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - John K Hewitt
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - Laura K Hink
- Department of Psychology and Neuroscience, University of Colorado-Boulder, Boulder, CO, USA
- Institute for Behavioral Genetics, University of Colorado-Boulder, Boulder, CO, USA
| | - JoAnn Robinson
- Department of Human Development and Family Studies, University of Connecticut, Storrs, CT, USA
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Jung M, Lee E. Specialised Teachers' Perceptions on the Management of Aggressive Behaviours in Children and Adolescents with Autism Spectrum Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238775. [PMID: 33255965 PMCID: PMC7729742 DOI: 10.3390/ijerph17238775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 11/21/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022]
Abstract
This study aimed to explore and describe the perception of specialized teachers regarding the management of aggressive behaviors in children and adolescents with autism spectrum disorders. Data were collected from 13 specialized teachers working in primary and secondary schools, using focus group interviews, and interview data were analyzed using an open coding method. The analysis of the specialized teachers’ perceptions of the management of aggression in children and adolescents with autism revealed the following results. A central theme “consistent practices to smooth edges” was conceptualized along with the categories: educational responses to individual behaviors, which had sub-themes of “identification of aggressive behavior patterns” and “strategic responses to aggressive behaviors observed”; experience in interventions for aggressive behaviors, with sub-themes of “individual intervention practices” and “school-led therapeutic support” and “factors preventing mitigation of aggression”; and acceptance of virtual reality (VR) based intervention model for aggression, with sub-themes of “acceptance of VR-based program applications” and “proposal for VR-based program contents.” Based on the specialized teachers’ perceptions examined in this study, more effective education and training intervention programs and support systems can be developed and provided for the management of aggressive behaviors in children and adolescents with autism.
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Affiliation(s)
- Miran Jung
- Department of Nursing, Baekseok University, Cheonan 31065, Korea;
| | - Eunmi Lee
- Department of Nursing, Research Institute for Basic Science, Hoseo University, Asan 31499, Korea
- Correspondence: ; Tel.: +82-41-540-9536
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13
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Distinct Empathy Profiles in Callous Unemotional and Autistic Traits: Investigating Unique and Interactive Associations with Affective and Cognitive Empathy. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1863-1873. [PMID: 31230188 DOI: 10.1007/s10802-019-00562-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Empathy deficits are a hallmark of both callous-unemotional (CU) and autistic traits. However, it is unclear whether each trait is associated with deficits in distinct empathy subcomponents. The aim of the current study was to investigate the main and interactive effects of CU and autistic traits in predicting affective and cognitive empathy. We used data of 163 children (Mage = 7.30, SD = 1.42, 44.2% girls), selected from a large community sample (N = 1652). To ensure variability in empathy, we recruited participants with either low (1 standard-deviation below the mean; n = 78) or average to high (n = 85) levels of empathy. Partial correlation and regression analysis revealed that autistic traits were negatively associated with cognitive empathy, whereas CU traits were negatively related with both cognitive and affective empathy. Importantly, this is the first study testing the moderating effects of gender, revealing that CU traits negatively predicted affective empathy only among girls high on autistic traits. Findings can be used to understand the different empathy profiles of children with CU or autistic traits, and inform the development of effective interventions.
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Melvin CL, Langdon PE, Murphy GH. "They're the hardest group to treat, that changes the least". Adapted sex offender treatment programmes for individuals with Autism Spectrum Disorders: Clinician views and experiences. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 105:103721. [PMID: 32650219 DOI: 10.1016/j.ridd.2020.103721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 05/01/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
AIMS Clinicians working with individuals with autism spectrum disorders (ASD) who display sexual offending behaviours may face challenges during treatment, as a result of the cognitive and behavioural profile associated with ASD. This research explored the views and experiences of those running adapted sex offender treatment groups with men with ASD. METHOD Semi-structured interviews with group facilitators (n = 12) focused on service user engagement and response to the core components of the treatment programme (e.g. increasing victim empathy, addressing cognitive distortions, etc.), and gathered the experiences of those working with men with ASD who display sexual offending behaviours. RESULTS Grounded Theory was used to develop a model conceptualising the potential impact of ASD on treatment outcomes, and this emerged predominantly through clinician's views of risk of re-offending. Benefits of attending a group included: the presence of other group members, a forum to develop pro-social roles and relationships, and increased opportunity for monitoring. Challenges regarding empathy, specifically emotional empathy, and shifts in cognitive distortions were felt particularly pertinent to those with ASD, as well as questions over internalisation of therapy. CONCLUSION Despite identification of a number of challenges, adapted sex offender treatment programmes were considered beneficial for men with ASD, especially in light of a dearth of evidenced-based alternatives.
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Affiliation(s)
- Clare L Melvin
- The University of East Anglia, Norwich, UK; The Tizard Centre, University of Kent, Canterbury, UK; Hertfordshire, Partnership University NHS Foundation Trust, The Broadland Clinic, Norfolk, UK.
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
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15
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Pehlivanidis A, Papanikolaou K, Mantas V, Kalantzi E, Korobili K, Xenaki LA, Vassiliou G, Papageorgiou C. Lifetime co-occurring psychiatric disorders in newly diagnosed adults with attention deficit hyperactivity disorder (ADHD) or/and autism spectrum disorder (ASD). BMC Psychiatry 2020; 20:423. [PMID: 32847520 PMCID: PMC7449076 DOI: 10.1186/s12888-020-02828-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Co-occurring psychiatric disorders in adults with Attention Deficit Hyperactivity Disorder (ADHD) and/or Autism Spectrum Disorder (ASD) contribute to the burden of the healthcare and possibly to the delay of diagnosis. Aim of the study was to clinically assess the prevalence and compare lifetime co-occurring psychopathology in a sample of newly diagnosed ADHD and/or ASD adults and discuss the diagnostic challenges they pose. METHODS The lifetime prevalence rates of ten of the most frequently co-occurring psychiatric diagnoses was registered in 336 adults of normal intelligence who underwent a thorough clinical evaluation for the diagnosis of ADHD and/or ASD for the first time in their lives. Four study groups were formed: the ADHD (n = 151), the ASD (n = 58), the ADHD+ASD (n = 28) and the nonADHD/nonASD (NN) (n = 88) group. RESULTS At least one co-occurring psychopathology was found in 72.8% of the ADHD group, in 50% of the ASD group, in 72.4% of the ADHD+ASD group and in 76.1% of the NN group (p = 0.004). In all groups the most frequent psychiatric disorder was depressive disorder. The only significant difference regarding the patterns of psychiatric co-occurrence between the ADHD and the nonADHD groups (ASD and NN groups) was found for SUD (p = 0.001). Also, the proportion of subjects with Bipolar Disorder was significantly greater in the NN group as compared to those with ASD (p = 0.025). CONCLUSIONS Our results support the high prevalence of co-occurring psychiatric disorders in adults with ADHD and/or ASD with the ASD group presenting the lowest rate. The most marked difference between the ADHD and the nonADHD groups was found for SUD. Moreover, our findings highlight the need for a thorough clinical assessment of all referred patients both in the presence and absence of ADHD and/or ASD.
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Affiliation(s)
- Artemios Pehlivanidis
- 1st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, "Eginition" Hospital, 72-74 Vas. Sofias Ave, 11528, Athens, Greece.
| | - Katerina Papanikolaou
- Department of Child Psychiatry, National and Kapodistrian University of Athens, Medical School, “Agia Sophia” Children’s Hospital, 11527 Athens, Greece
| | - Vasilios Mantas
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Eva Kalantzi
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Kalliopi Korobili
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Lida-Alkisti Xenaki
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Georgia Vassiliou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
| | - Charalambos Papageorgiou
- grid.5216.00000 0001 2155 08001st Department of Psychiatry, National and Kapodistrian University of Athens, Medical School, “Eginition” Hospital, 72-74 Vas. Sofias Ave, 11528 Athens, Greece
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16
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Callous-unemotional traits in youth with autism spectrum disorder (ASD): replication of prevalence estimates and associations with gaze patterns when viewing fearful faces. Dev Psychopathol 2020; 33:1220-1228. [PMID: 32594962 PMCID: PMC8564715 DOI: 10.1017/s0954579420000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research suggests an increased prevalence of callous-unemotional (CU) traits in children with autism spectrum disorder (ASD), and a similar impairment in fear recognition to that reported in non-ASD populations. However, past work has used measures not specifically designed to measure CU traits and has not examined whether decreased attention to the eyes reported in non-ASD populations is also present in individuals with ASD. The current paper uses a measure specifically designed to measure CU traits to estimate prevalence in a large community-based ASD sample. Parents of 189 adolescents with ASD completed questionnaires assessing CU traits, and emotional and behavioral problems. A subset of participants completed a novel emotion recognition task (n = 46). Accuracy, reaction time, total looking time, and number of fixations to the eyes and mouth were measured. Twenty-two percent of youth with ASD scored above a cut-off expected to identify the top 6% of CU scores. CU traits were associated with longer reaction times to identify fear and fewer fixations to the eyes relative to the mouth during the viewing of fearful faces. No associations were found with accuracy or total looking time. Results suggest the mechanisms that underpin CU traits may be similar between ASD and non-ASD populations.
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17
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Barnoux M, Alexander R, Bhaumik S, Devapriam J, Duggan C, Shepstone L, Staufenberg E, Turner D, Tyler N, Viding E, Langdon PE. The face validity of an initial sub-typology of people with autism spectrum disorders detained in psychiatric hospitals. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:1885-1897. [PMID: 32564628 PMCID: PMC7543018 DOI: 10.1177/1362361320929457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Autistic adults who have a history of committing crimes present a major problem for providers of services in terms of legal disposal options and possible interventions, and greater understanding of this group and their associated needs is required. For this reason, we aimed to investigate the face validity of a proposed sub-typology of autistic adults detained in secure psychiatric hospitals in the United Kingdom. Initially, a focus group was completed with psychiatrists, clinical psychologists, healthcare workers, family members and autistic adults who had been detained in hospital, leading to revisions of the sub-typology. Following this, a consensus rating exercise of 10 clinical vignettes based on this sub-typology with three rounds was completed with 15 psychiatrists and clinical psychologists; revisions to the vignettes to improve clarity were made following each round. The findings indicated that these subtypes possess face validity and raters were able to classify all 10 clinical case vignettes into the sub-typology, and percentage of agreement ranged from 96% to 100% for overall subtype classification. This study suggests that the further validity of the sub-typology should be investigated within a larger study, as these subtypes have the potential to directly inform the hospital care pathway such that length of stay can be minimised.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Peter E Langdon
- Coventry and Warwickshire Partnership NHS Trust and University of Warwick, UK
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18
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Murphy D. Autism: Implications for high secure psychiatric care and move towards best practice. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103615. [PMID: 32113075 DOI: 10.1016/j.ridd.2020.103615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 01/30/2020] [Accepted: 02/20/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND/AIMS To explore the role of high secure psychiatric care (HSPC) in the assessment and management of individuals with an Autism Spectrum Disorder (ASD) using published studies and clinical experience. Key areas of exploration include the prevalence of ASD within HSPC, some autism specific issues including clinical and cognitive characteristics, psychopathy and emotional regulation, presence of incompatibilities and use of seclusion, as well as experiences of being detained in HSPC. Developing best practice and a specialist ASD service in HSPC is also discussed. METHOD A discussion of available literature, supported by clinical experience. CONCLUSIONS Although individuals with an ASD admitted to HSPC comprise a small group, they are likely to be overrepresented relative to the general prevalence of ASD in the population and present with specific issues. Whilst individuals report a generally positive experience of HSPC, therapeutic outcomes are variable and the factors influencing them poorly understood. Staff knowledge and application of ASD theory and practice appears to have a significant influence on outcomes. IMPLICATIONS Although best practice concerning ASD secure services will continue to be improved and developed, the role of HSPC in the assessment and management of some individuals with an ASD who present with complex needs and high risk behaviours remains clear.
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Affiliation(s)
- David Murphy
- Broadmoor High Secure Psychiatric Hospital, Crowthorne, RG457EG, Berkshire, United Kingdom.
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19
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Woodbury-Smith M. Conceptualising social and communication vulnerabilities among detainees in the criminal justice system. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 100:103611. [PMID: 32109817 DOI: 10.1016/j.ridd.2020.103611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/11/2020] [Accepted: 02/11/2020] [Indexed: 06/10/2023]
Abstract
More people with autism spectrum disorder (ASD) are now being identified in the criminal justice system, and in parallel with this increase, the prevalence of ASD in the community has risen more than 150 % in the same time period. In this article, I will argue that this increase is due to a reclassification of those individuals whose social, communicative and behavioural function is at the lower end of the normal range. Put simply, extremes of these quantitative traits are now being conceptualised as 'disorder'. This has particular relevance for the criminal justice system as such traits are over-represented in this population: as such, it is likely that increasing numbers of people who are incarcerated will receive an ASD diagnosis. This will have major implications for where best, and how best, to manage such individuals using a framework of 'disorder' versus 'difference'.
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20
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Malik S, Young K, Walker S, Loftus M. A Novel Approach to Assess Violent and Homicidal Ideation: The I-HAVAT©. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676608666181016161516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Child and adolescent psychiatrists and clinicians often assess
individuals who present with homicidal and violent thoughts. These assessments are critical,
for patient safety and societal protection. The psychiatrist must ultimately decide if the
patient can return to the community safely, regardless if the patient has initially presented to
inpatient, outpatient, emergency room or school settings. While there is some consensus
regarding the best practice in assessing risk for serious self-harm, approaches to the
assessment of homicide and violence are far more disparate. Clinicians often determine risk
based on known risk factors and type of violence threatened, and many offer a “risk level”.
However, in the absence of an easy to use tool to assess risk, the judgment relies on clinician
experience, talent and training, at the expense of a uniform, organized and comprehensive
approach.
Methods:
We describe an assessment tool that uses a semi-structured interview to
comprehensively evaluate an individual’s risk for violence. The tool guides the clinician to
gather a detailed description of the current episode, then reviews the salient risk and
protective factors and ends with a structured mental status exam developed to help
characterize typical pathways to violence.
Discussion:
The steps in assessing children and adolescents presenting with homicidal
threats in various clinical settings, as well as the steps in determining the appropriate level of
care and treatment plan, will be discussed. The implementation of the assessment tool in an
inpatient setting and the clinicians’ reaction to using it will also be discussed.
Conclusion:
The I-HAVAT© (Institute of Living-Homicide and Violence Assessment Tool)
is a semi-structured method of assessing patients presenting with violent or homicidal threats
by collecting and streamlining pertinent clinical information and ultimately increases the
clinicians’ confidence level in making decisions and recommendations for determining the
level of care and appropriate treatment plan.
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Affiliation(s)
- Salma Malik
- SIDRA Medical and Research Center, Doha, Qatar
| | - Kevin Young
- Institute of Living/Hartford Hospital, Hartford, Connecticut, United States
| | - Sophia Walker
- Institute of Living/Hartford Hospital, Hartford, Connecticut, United States
| | - Mirela Loftus
- Institute of Living/Hartford Hospital, Hartford, Connecticut, United States
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21
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Weisbrot DM. "The Need to See and Respond": The Role of the Child and Adolescent Psychiatrist in School Threat Assessment. J Am Acad Child Adolesc Psychiatry 2020; 59:20-26. [PMID: 31879009 DOI: 10.1016/j.jaac.2019.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/02/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
Abstract
Child and adolescent psychiatrists are on the front lines of performing challenging school threat assessments. With respect to school climate, clinicians should be aware of the presence of zero tolerance policies and inappropriate profiling. Removing a student from school does not eliminate the risk to the school community. School shootings often present similarly horrific themes and failures to respond properly to warning signs. Threatening communications in social media posts, drawings, and writings are significant clues to potential violence. Fascination with prior mass shooters is a potential high-risk warning sign. Thorough assessment of weapon access is essential. If there are significant concerns about a student's Internet activities, police can access a student's telephone and computer; the Federal Bureau of Investigation can also be contacted. Even if a threat appears to be relatively minor, a comprehensive psychiatric evaluation should still be performed, as important psychiatric concerns may be present. After threat assessment completion, it can be extremely challenging to find appropriate school placements for students with complex psychiatric problems who make serious threats. If indicated, a judge can order a forensic evaluation or remand the student to a hospital or residential programs. Ultimately, it is up to the psychiatrist to decide on the severity of the threat and the proper course of action, in collaboration with a school-based threat assessment team. The child and adolescent psychiatrist who performs a comprehensive threat assessment is likely to be in the best position to make these judgments to ensure the safety of all.
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Affiliation(s)
- Deborah M Weisbrot
- Division of Child and Adolescent Psychiatry, The Renaissance School of Medicine at Stony Brook University, New York, NY.
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22
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Ibrahim K, Eilbott JA, Ventola P, He G, Pelphrey KA, McCarthy G, Sukhodolsky DG. Reduced Amygdala-Prefrontal Functional Connectivity in Children With Autism Spectrum Disorder and Co-occurring Disruptive Behavior. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2019; 4:1031-1041. [PMID: 30979647 PMCID: PMC7173634 DOI: 10.1016/j.bpsc.2019.01.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/18/2019] [Accepted: 01/21/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Disruptive behaviors are prevalent in children with autism spectrum disorder (ASD) and often cause substantial impairments. However, the underlying neural mechanisms of disruptive behaviors remain poorly understood in ASD. In children without ASD, disruptive behavior is associated with amygdala hyperactivity and reduced connectivity with the ventrolateral prefrontal cortex (vlPFC). This study examined amygdala reactivity and connectivity in children with ASD with and without co-occurring disruptive behavior disorders. We also investigated differential contributions of externalizing behaviors and callous-unemotional traits to variance in amygdala connectivity and reactivity. METHODS This cross-sectional study involved behavioral assessments and neuroimaging in three groups of children 8 to 16 years of age: 18 children had ASD and disruptive behavior, 20 children had ASD without disruptive behavior, and 19 children were typically developing control participants matched for age, gender, and IQ. During functional magnetic resonance imaging, participants completed an emotion perception task of fearful versus calm faces. Task-specific changes in amygdala reactivity and connectivity were examined using whole-brain, psychophysiological interaction, and multiple regression analyses. RESULTS Children with ASD and disruptive behavior showed reduced amygdala-vlPFC connectivity compared with children with ASD without disruptive behavior. Externalizing behaviors and callous-unemotional traits were associated with amygdala reactivity to fearful faces in children with ASD after controlling for suppressor effects. CONCLUSIONS Reduced amygdala-vlPFC connectivity during fear processing may differentiate children with ASD and disruptive behavior from children with ASD without disruptive behavior. The presence of callous-unemotional traits may have implications for identifying differential patterns of amygdala activity associated with increased risk of aggression in ASD. These findings suggest a neural mechanism of emotion dysregulation associated with disruptive behavior in children with ASD.
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Affiliation(s)
- Karim Ibrahim
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.
| | - Jeffrey A Eilbott
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - Pamela Ventola
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
| | - George He
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Kevin A Pelphrey
- Department of Neurology, University of Virginia School of Medicine, Charlottesville, Virginia
| | - Gregory McCarthy
- Department of Psychology, Yale University, New Haven, Connecticut
| | - Denis G Sukhodolsky
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut.
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23
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Detailing the understanding of moral judgements in autism. A study with Spanish-speaking children. COGNITIVE DEVELOPMENT 2019. [DOI: 10.1016/j.cogdev.2019.100815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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24
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Margoni F, Guglielmetti G, Surian L. Brief Report: Young Children with Autism Can Generate Intent-Based Moral Judgments. J Autism Dev Disord 2019; 49:5078-5085. [PMID: 31489539 DOI: 10.1007/s10803-019-04212-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Past research suggested that, due to difficulties in mentalistic reasoning, individuals with autism tend to base their moral judgments on the outcome of agents' actions rather than on agents' intentions. In a novel task, aimed at reducing the processing demands required to represent intentions and generate a judgment, autistic children were presented with agents that accidentally harmed or attempted but failed to harm others and were asked to judge those agents. Most of the times, children blamed the character who attempted to harm and exculpated the accidental wrongdoer, suggesting that they generated intent-based moral judgments. These findings suggest that processing limitations rather than lack of conceptual competence explain the poor performance reported in previous research on moral judgment in autism.
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Affiliation(s)
- Francesco Margoni
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini 31, 38068, Rovereto, TN, Italy.
| | | | - Luca Surian
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini 31, 38068, Rovereto, TN, Italy.
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25
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Bedford R, Gliga T, Hendry A, Jones EJH, Pasco G, Charman T, Johnson MH, Pickles A. Infant regulatory function acts as a protective factor for later traits of autism spectrum disorder and attention deficit/hyperactivity disorder but not callous unemotional traits. J Neurodev Disord 2019; 11:14. [PMID: 31351456 PMCID: PMC6660706 DOI: 10.1186/s11689-019-9274-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 07/08/2019] [Indexed: 11/10/2022] Open
Abstract
Background Reduced executive functions (EF) are commonly associated with developmental conditions (e.g., autism spectrum disorder, ASD; attention deficit/hyperactivity disorder, ADHD), although EF seems to be typical in children with callous unemotional (CU) traits. Regulatory function (RF) is a proposed infant precursor that maps on onto factors driving later EF. Here, we first test whether RF is specifically and negatively associated with ASD and ADHD traits, but not CU traits. Second, we test whether RF can act as a protective factor, by moderating the association between infant markers and subsequent ASD and ADHD traits. Methods Participants were 79 infants at high (N = 42) and low (N = 37) familial risk for ASD. Data come from the 14-month infant visit (Autism Observational Scale for Infants; AOSI; activity level and RF from the Infant Behavior Questionnaire; IBQ) and the 7-year visit (ASD traits: Social Responsiveness Scale, SRS; ADHD traits: Conners 3, CU traits: Inventory of Callous Unemotional Traits). Results Infant RF was negatively associated with later traits of ASD (B = − 0.5, p = 0.01) and ADHD inattention (B = − 0.24, p = 0.02) but not hyperactivity (B = − 0.25, p = 0.10) or CU traits (B = 0.02, p = 0.86). RF moderated the association between infant AOSI score and ASD traits, with a significant effect in those with low RF (B = 0.10, p = 0.006), not high RF (B = 0.01, p = 0.78). Similarly, for ADHD, infant activity level was associated with later ADHD inattention in those with low (B = 0.17, p = 0.04) but not high RF (B = 0.07, p = 0.48). For ADHD hyperactivity symptoms, activity level was predictive at both high and low levels of RF. Conclusions Strong RF may allow children to compensate for other atypicalities, thus attenuating the association between infant markers and later disorder traits. Whilst infant RF was associated with both ASD and ADHD inattention traits, there was no association with ADHD hyperactivity or CU traits. This suggests that any protective effect may not be universal and emphasises the need for a better understanding of the underlying moderating mechanisms. Electronic supplementary material The online version of this article (10.1186/s11689-019-9274-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Rachael Bedford
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Teodora Gliga
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
| | - Alexandra Hendry
- Experimental Psychology Department, Oxford University, Oxford, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK
| | - Greg Pasco
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Tony Charman
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Birkbeck College, University of London, London, UK.,Psychology Department, Cambridge University, Cambridge, UK
| | - Andrew Pickles
- Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Nikolić M, van der Storm L, Colonnesi C, Brummelman E, Kan KJ, Bögels S. Are Socially Anxious Children Poor or Advanced Mindreaders? Child Dev 2019; 90:1424-1441. [PMID: 31099053 PMCID: PMC6852401 DOI: 10.1111/cdev.13248] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Why are some children more socially anxious than others? One theory holds that socially anxious children are poor mindreaders, which hampers their social interactions; another that socially anxious children are advanced mindreaders leading to heightened self-consciousness in social situations. To test these theories simultaneously, this study (N = 105, ages 8-12) assessed children's mindreading (accuracy in detecting mental states from the eye region), self-consciousness (indexed as physiological blushing during public performance), and social anxiety levels. Results support both theories, showing a quadratic relation between mindreading and social anxiety. Low mindreading was related to clinical levels of social anxiety. High mindreading was related to subclinical levels of social anxiety through blushing. Our findings suggest two social-cognitive pathways to heightened social anxiety.
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Murphy D, Allely C. Autism spectrum disorders in high secure psychiatric care: a review of literature, future research and clinical directions. ADVANCES IN AUTISM 2019. [DOI: 10.1108/aia-10-2018-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to review available literature targeting the assessment and management of individuals with an autism spectrum disorder (ASD) admitted to high secure psychiatric care (HSPC). Key areas of examination include the prevalence of ASD in HSPC, how individuals with an ASD differ from other patient groups in clinical and cognitive characteristics, the views of staff regarding patients with an ASD, an exploration of the experiences and quality of life of patients with an ASD, as well as treatment and interventions.
Design/methodology/approach
A review of the published literature.
Findings
Although individuals with an ASD comprise a relatively small proportion of the total HSPC cohort, they appear to be over represented relative to the general population prevalence. Several research projects suggest that individuals with an ASD present with difficulties and needs different to other patient groups, as well as being viewed by staff as potentially vulnerable and requiring a different care approach. Individuals with an ASD report both positive and negative aspects to life in HSPC.
Practical implications
Suggestions are made with regard to how individuals with an ASD might be better managed in HSPC. Following the spirit of various pieces of government legislation such as the Autism Act (2009) and the Equalities Act (2010) the role of a specialist ASD HSPC service is proposed.
Originality/value
This paper provides a detailed review of the research to date exploring the assessment and management of individuals with an ASD detained in HSPC. It outlines key research findings, highlights limitations with it and provides a personal perspective on future research and clinical targets.
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Hofvander B, Bering S, Tärnhäll A, Wallinius M, Billstedt E. Few Differences in the Externalizing and Criminal History of Young Violent Offenders With and Without Autism Spectrum Disorders. Front Psychiatry 2019; 10:911. [PMID: 31920758 PMCID: PMC6927936 DOI: 10.3389/fpsyt.2019.00911] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 11/18/2019] [Indexed: 11/13/2022] Open
Abstract
Autism spectrum disorders (ASDs) are known to be associated with an increased risk of aggression and challenging behavior. In this study, we have mapped the externalizing history of a nationally representative cohort of young violent offenders with ASD, compared with offenders without ASD. Two hundred and sixty-nine violent offenders were assessed for prevalence of ASD, and participated in a thorough assessment of previous externalizing problems and criminal history. Twenty-six offenders met consensus clinical DSM-IV criteria for ASD and they were compared to offenders without ASD from the same cohort. Overall, we found a very high prevalence of externalizing and antisocial behaviors in the history of these offenders and there were few differences between the groups. Placements in foster homes were overrepresented in the ASD group and the ASD-offenders had significantly more often been diagnosed with a neurodevelopmental disorder (i.e. ASD or ADHD) by a clinician before the study. At index conviction, ASD offenders were overrepresented in sex crimes with a child victim. Though offenders without ASD had more previous convictions, in particular drug crimes, we found no difference in terms of total number of prosecuted crimes. Substance use disorders were more common among offenders without ASD. The ASD offenders scored higher compared to the non-ASD offenders on the Affective facet of the Psychopathy Checklist-Revised (PCL-R) but there were no differences in terms of total PCL-R scores. Our results provide important knowledge of the developmental history of offenders with ASD. Though this is a small and atypical phenotype it poses significant challenges to the criminal justice system and we need to understand more of it to be able to prevent these individuals from committing crimes but also to provide a fair judicial treatment, to assess exculpatory factors and improve our forensic treatment models.
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Affiliation(s)
- Björn Hofvander
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Sophie Bering
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - André Tärnhäll
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Märta Wallinius
- Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Centre of Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Associations Between Conduct Disorder, Neurodevelopmental Problems and Psychopathic Personality Traits in a Swedish Twin Youth Population. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2018; 40:586-592. [PMID: 30459483 PMCID: PMC6223811 DOI: 10.1007/s10862-018-9689-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Previous research has found a complex relationship between psychopathic traits, neurodevelopmental problems (NDPs), and conduct disorder (CD) in children. This study explores associations between psychopathic traits, assessed with the Child Problematic Traits Inventory-Short Version (CPTI-SV), and CD in children with and without coexisting NDPs (i.e., attention deficit/hyperactivity disorder [ADHD] and autism spectrum disorder [ASD]) in a community-based sample of Swedish twins (n = 8762). Findings indicate weak to moderately strong correlations between psychopathic traits and CD, ADHD, and ASD, respectively. Furthermore, in univariable analyses, both psychopathic traits and NDPs displayed significant positive associations with being screened positive for CD, though only the grandiose-deceitful dimension of CPTI-SV and the ADHD domain concentration and attention deficits remained significantly associated with CD in a multivariable regression model. The results are relevant to screening and assessment in child and youth psychiatry, as a grandiose and deceitful interpersonal style may also be a valid sign of children at risk of developing CD.
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30
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Ali S. Autistic spectrum disorder and offending behaviour – a brief review of the literature. ADVANCES IN AUTISM 2018. [DOI: 10.1108/aia-05-2018-0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper to synthesise much of the existing research on autistic spectrum disorder (ASD) and offending behaviour.
Design/methodology/approach
It considers three key areas, namely, first, a discussion about the nature of ASD and how it might be related to offending behaviour; second, a brief commentary about the prevalence of this population; and, finally, an exploration of the effective management and possible treatment outcomes.
Findings
Methodological limitations have resulted in variable findings which has hindered our understanding of this population. Some of the research is based on small, highly specialist samples making prevalence difficult to measure. The link between ASD and offending is still not well understood, and despite advances in staff training, awareness amongst practitioners remains an underdeveloped area, thus yielding variable treatment outcomes.
Originality/value
This review continues to demonstrate the urgent need for robust research in order to better understand the link between ASD and offending behaviour, to provide tailored, needs-led interventions, and reduce the risk of offending amongst this group as a whole.
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Bours CCAH, Bakker-Huvenaars MJ, Tramper J, Bielczyk N, Scheepers F, Nijhof KS, Baanders AN, Lambregts-Rommelse NNJ, Medendorp P, Glennon JC, Buitelaar JK. Emotional face recognition in male adolescents with autism spectrum disorder or disruptive behavior disorder: an eye-tracking study. Eur Child Adolesc Psychiatry 2018; 27:1143-1157. [PMID: 29922873 PMCID: PMC6133091 DOI: 10.1007/s00787-018-1174-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 05/22/2018] [Indexed: 01/10/2023]
Abstract
Autism Spectrum Disorder (ASD), Oppositional Defiant Disorder (ODD), and Conduct Disorder (CD) are often associated with emotion recognition difficulties. This is the first eye-tracking study to examine emotional face recognition (i.e., gazing behavior) in a direct comparison of male adolescents with Autism Spectrum Disorder or Oppositional Defiant Disorder/Conduct Disorder, and typically developing (TD) individuals. We also investigate the role of psychopathic traits, callous-unemotional (CU) traits, and subtypes of aggressive behavior in emotional face recognition. A total of 122 male adolescents (N = 50 ASD, N = 44 ODD/CD, and N = 28 TD) aged 12-19 years (M = 15.4 years, SD= 1.9) were included in the current study for the eye-tracking experiment. Participants were presented with neutral and emotional faces using a Tobii 1750 eye-tracking monitor to record gaze behavior. Our main dependent eye-tracking variables were: (1) fixation duration to the eyes of a face and (2) time to the first fixation to the eyes. Since distributions of eye-tracking variables were not completely Gaussian, non-parametric tests were chosen to investigate gaze behavior across the diagnostic groups with Autism Spectrum Disorder, Oppositional Defiant Disorder/Conduct Disorder, and Typically Developing individuals. Furthermore, we used Spearman correlations to investigate the links with psychopathy, callous, and unemotional traits and subtypes of aggression as assessed by questionnaires. The relative total fixation duration to the eyes was decreased in both the Autism Spectrum Disorder group and the Oppositional Defiant Disorder/Conduct Disorder group for several emotional expressions. In both the Autism Spectrum Disorder and the Oppositional Defiant Disorder/Conduct Disorder group, increased time to first fixation on the eyes of fearful faces only was nominally significant. The time to first fixation on the eyes was nominally correlated with psychopathic traits and proactive aggression. The current findings do not support strong claims for differential cross-disorder eye-gazing deficits and for a role of shared underlying psychopathic traits, callous-unemotional traits, and aggression subtypes. Our data provide valuable and novel insights into gaze timing distributions when looking at the eyes of a fearful face.
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Affiliation(s)
- C C A H Bours
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - M J Bakker-Huvenaars
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J Tramper
- Centre for Cognition, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - N Bielczyk
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - F Scheepers
- Brain Center Rudolf Magnus, UMC Utrecht, Utrecht, The Netherlands
| | - K S Nijhof
- Pluryn, Hoenderloo, The Netherlands
- Department of Developmental Psychology, Radboud University, Nijmegen, The Netherlands
| | - A N Baanders
- Stichting Otto Gerhard Heldring, Zetten, The Netherlands
| | - N N J Lambregts-Rommelse
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
- Department of Psychiatry, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - P Medendorp
- Centre for Cognition, Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - J C Glennon
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - J K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, Nijmegen, The Netherlands
- Karakter Child and Adolescent Psychiatry University Centre Nijmegen, Nijmegen, The Netherlands
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Green J, Absoud M, Grahame V, Malik O, Simonoff E, Le Couteur A, Baird G. Pathological Demand Avoidance: symptoms but not a syndrome. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:455-464. [PMID: 30169286 DOI: 10.1016/s2352-4642(18)30044-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 01/19/2018] [Accepted: 01/29/2018] [Indexed: 02/02/2023]
Abstract
Pathological (or extreme) demand avoidance is a term sometimes applied to complex behaviours in children within-or beyond-autism spectrum disorder. The use of pathological demand avoidance as a diagnosis has, at times, led to altered referral practice and misunderstandings between professionals and the families of patients. In our Viewpoint, we reviewed the current literature and conclude that the evidence does not support the validity of pathological demand avoidance as an independent syndrome. Nevertheless, the use of the term highlights an important known range of co-occurring difficulties for many children with autism spectrum disorder that can substantially affect families. We explore how these difficulties can best be understood through understanding of social, sensory, and cognitive sensitivities in autism spectrum disorder, identification of frequently occurring comorbid conditions, and assessment of how these problems interact within the child's social environment. Such understanding should then inform individualised management strategies for children and families, and in social settings, such as education. It is crucial that a shared understanding is achieved between professionals and families in this area.
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Affiliation(s)
- Jonathan Green
- Division of Neuroscience and Experimental Psychology, University of Manchester, Manchester, UK; Manchester University NHS Foundation Trust, Greater Manchester Mental Health NHS Foundation Trust, and Manchester Academic Health Sciences Centre, Manchester, UK.
| | - Michael Absoud
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's Health Partners Academic Health Science Centre, London, UK; Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | | | - Osman Malik
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's Health Partners Academic Health Science Centre, London, UK
| | - Emily Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Ann Le Couteur
- Newcastle University, Newcastle upon Tyne, UK; Northumberland Tyne and Wear NHS Trust, Newcastle upon Tyne, UK
| | - Gillian Baird
- Department of Children's Neurosciences, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK; King's Health Partners Academic Health Science Centre, London, UK
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Higher Autistic Traits Among Criminals, But No Link to Psychopathy: Findings from a High-Security Prison in Portugal. J Autism Dev Disord 2018; 48:3010-3020. [PMID: 29651681 DOI: 10.1007/s10803-018-3576-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The relationship between autism, criminality and psychopathy has gained increased attention in recent years, although research has focused on autism spectrum disorders, and not autistic traits. We measured autistic traits (with the Autism Spectrum Quotient) in a sample of 101 inmates from a high-security prison and compared them to a control group, using a logistic regression model that included age, education, psychopathology, psychopathy and attention deficit-hyperactivity disorder as covariates. Prisoners had more autistic traits (OR 1.13, p = 0.002) due to higher scores in the communication (OR 1.23) and imagination (OR 1.30) domains. No correlations were found between autistic and psychopathic traits. Our study points to the presence of autistic traits as being independent risk factors for imprisonment, although not associated with psychopathy.
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34
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Murphy D. Understanding offenders with autism-spectrum disorders: what can forensic services do? ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.109.006775] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryThis commentary aims to support and elaborate on some of the specific issues raised by Dein & Woodbury-Smith. Although I agree with many of their comments, I believe that the role of neuropsychological and sensory impairments, as well as dysfunctional coping strategies among individuals with an autism-spectrum disorder who offend, need to be expanded from a psychological perspective. In my experience, the assessment of these factors plays a crucial role in guiding opinions on mental capacity, individual interventions, risk assessment and management. Elements of psychopathy in autism also require clarification. It could be argued that by understanding these issues, any attempts at social inclusion and preventing offending will be more successful.
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Gillespie SM, Mitchell IJ, Abu-Akel AM. Autistic traits and positive psychotic experiences modulate the association of psychopathic tendencies with theory of mind in opposite directions. Sci Rep 2017; 7:6485. [PMID: 28743994 PMCID: PMC5526986 DOI: 10.1038/s41598-017-06995-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 06/21/2017] [Indexed: 12/19/2022] Open
Abstract
Various clinical disorders, including psychopathy, and autism and schizophrenia spectrum disorders, have been linked with impairments in Theory of Mind (ToM). However, although these conditions can co-occur in the same individual, the effect of their inter-play on ToM abilities has not been investigated. Here we assessed ToM abilities in 55 healthy adults while performing a naturalistic ToM task, requiring participants to watch a short film and judge the actors' mental states. The results reveal for the first time that autistic traits and positive psychotic experiences interact with psychopathic tendencies in opposite directions to predict ToM performance-the interaction of psychopathic tendencies with autism traits was associated with a decrement in performance, whereas the interaction of psychopathic tendencies and positive psychotic experiences was associated with improved performance. These effects were specific to cognitive rather than affective ToM. These results underscore the importance of the simultaneous assessment of these dimensions within clinical settings. Future research in these clinical populations may benefit by taking into account such individual differences.
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Affiliation(s)
| | - Ian J Mitchell
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Ahmad M Abu-Akel
- Institute of Psychology, University of Lausanne, Lausanne, 1015, Switzerland
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Mittal VA, Wakschlag LS. Research domain criteria (RDoC) grows up: Strengthening neurodevelopment investigation within the RDoC framework. J Affect Disord 2017; 216:30-35. [PMID: 28010957 PMCID: PMC5471127 DOI: 10.1016/j.jad.2016.12.011] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 12/12/2016] [Indexed: 01/06/2023]
Affiliation(s)
- Vijay A Mittal
- Northwestern University, Department of Psychology, 2029 Sheridan Road, Evanston, IL 60208, USA; Northwestern University, Department of Psychiatry, Feinberg School of Medicine, Chicago, IL, USA; Northwestern University, Institute for Policy Research, Evanston, IL, USA; Northwestern University, Department of Medical Social Sciences, Feinberg School of Medicine, Chicago IL, USA; Northwestern University, Institute for Innovations in Developmental Sciences, Evanston, IL, USA.
| | - Lauren S Wakschlag
- Northwestern University, Institute for Policy Research, Evanston, IL, USA; Northwestern University, Department of Medical Social Sciences, Feinberg School of Medicine, Chicago IL, USA; Northwestern University, Institute for Innovations in Developmental Sciences, Evanston, IL, USA
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Tye C, Bedford R, Asherson P, Ashwood KL, Azadi B, Bolton P, McLoughlin G. Callous-unemotional traits moderate executive function in children with ASD and ADHD: A pilot event-related potential study. Dev Cogn Neurosci 2017; 26:84-90. [PMID: 28654838 PMCID: PMC5569583 DOI: 10.1016/j.dcn.2017.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 06/06/2017] [Accepted: 06/07/2017] [Indexed: 11/25/2022] Open
Abstract
Children with ASD and ADHD show varied and heterogeneous executive function (EF) profiles. Typical or enhanced EF has been demonstrated in individuals with callous-unemotional (CU) traits. We investigated the effect of CU traits on event-related potential (ERP) responses during a cued continuous performance test (CPT-OX) in children with ASD, ADHD and co-occurring ASD + ADHD. Children with ASD and high CU traits showed better conflict monitoring compared to children with ASD and low CU traits. Increased CU traits may be associated with cognitive strengths in children with ASD.
Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are associated with varied executive function (EF) difficulties. Callous-unemotional (CU) traits, a proposed antecedent of adult psychopathy, are often associated with intact or enhanced EF. Here we test whether CU traits may therefore modulate EF in ASD and ADHD, in which EF is typically impaired. We collected CU traits and measured event-related potentials (ERPs) that index EF during a cued-continuous performance test (CPT-OX) in boys with ASD, ADHD, comorbid ASD + ADHD and typical controls. We examined attentional orienting at cues (Cue-P3), inhibitory processing at non-targets (NoGo-P3) and conflict monitoring between target and non-target trials (Go-N2 vs. NoGo-N2). In children with ASD, higher CU traits were associated with an enhanced increase in N2 amplitude in NoGo trials compared to Go trials, which suggests relatively superior conflict monitoring and a potential cognitive strength associated with CU traits. The results emphasise the importance of considering the effects of co-occurring traits in the assessment of heterogeneity of EF profiles in neurodevelopmental disorders.
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Affiliation(s)
- C Tye
- King's College London, MRC SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom; King's College London, Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom.
| | - R Bedford
- King's College London, Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom
| | - P Asherson
- King's College London, MRC SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom
| | - K L Ashwood
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom
| | - B Azadi
- King's College London, MRC SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom
| | - P Bolton
- King's College London, MRC SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom; King's College London, Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom
| | - G McLoughlin
- King's College London, MRC SGDP Centre, Institute of Psychiatry, Psychology & Neuroscience, United Kingdom
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Smith A. The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395675] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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39
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Smith A. The Empathy Imbalance Hypothesis of Autism: A Theoretical Approach to Cognitive and Emotional Empathy in Autistic Development. PSYCHOLOGICAL RECORD 2017. [DOI: 10.1007/bf03395663] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Pijper J, de Wied M, van Rijn S, van Goozen S, Swaab H, Meeus W. Callous unemotional traits, autism spectrum disorder symptoms and empathy in boys with oppositional defiant disorder or conduct disorder. Psychiatry Res 2016; 245:340-345. [PMID: 27575651 DOI: 10.1016/j.psychres.2016.08.053] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 08/15/2016] [Accepted: 08/15/2016] [Indexed: 11/25/2022]
Abstract
This study examined additive and interactive effects of callous unemotional (CU) traits and autism spectrum disorders (ASD) symptoms in relation to trait empathy, in boys with oppositional defiant disorder (ODD) or conduct disorder (CD). Participants were 49 boys with ODD/CD, aged between 7-12 years. Boys completed a questionnaire measure of empathic sadness and a broader questionnaire measure of affective and cognitive empathy. Parents and teachers reported on CU traits, and parents reported on ASD symptoms. In agreement with predictions, results reveal a negative association between CU traits and empathic sadness, particularly strong for ODD/CD boys with low levels of ASD symptoms. Results also reveal a negative association between ASD symptoms and cognitive empathy. Findings suggest that CU traits and ASD symptoms are associated with distinct empathy deficits with poor empathic sadness being more typical of CU traits than ASD symptoms.
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Affiliation(s)
- Jarla Pijper
- Adolescent Development, Utrecht University, Utrecht, The Netherlands.
| | - Minet de Wied
- Adolescent Development, Utrecht University, Utrecht, The Netherlands
| | - Sophie van Rijn
- Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands
| | - Stephanie van Goozen
- Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands; School of Psychology, Cardiff University, Cardiff, United Kingdom
| | - Hanna Swaab
- Clinical Child and Adolescent Studies, Leiden University, Leiden, The Netherlands
| | - Wim Meeus
- Adolescent Development, Utrecht University, Utrecht, The Netherlands; Developmental Psychology, Tilburg University, Tilburg, The Netherlands
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Abstract
Purpose
Previous prevalence studies of likely autistic spectrum condition (ASC) within criminal justice settings have focussed on specialist forensic mental health settings. The purpose of this paper is to examine prevalence of autism in a general community forensic sample.
Design/methodology/approach
In total, 336 offenders managed by a probation office were administered with a recognised screening tool to identify likely autism (AQ-10). Screenings were scored and those above the threshold were identified, where possible further diagnostic information was sought on positive-screened cases.
Findings
In total, 4.5 per cent (15 offenders) of the caseload screened positive for autism. Descriptive demographic information such as gender, age and offence type is provided for this group. Further diagnostic information was available on eight of the cases. Three already had an autism diagnosis and further psychometric assessment indicated that a further three cases were 80 per cent likely to be diagnosable with autism.
Research limitations/implications
Demographic information on the sample could not be compared with norms across the whole probation caseload due to limitation of resources for the project. No further diagnostic information was available on six offenders who screened positive for autism.
Practical implications
The research indicates that autism is not substantially over-represented in a large community offender sample although further research is required to identify the full degree of representation.
Social implications
Different kinds of offences are observed to be committed by offenders who do exhibit autism. It would be useful for criminal justice staff to have a general knowledge about autism, also how people with autism might offend and how they might best be supervised by probation services.
Originality/value
This is the first study of its kind internationally to examine prevalence of autism in a general community forensic sample.
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Alexander R, Langdon PE, Chester V, Barnoux M, Gunaratna I, Hoare S. Heterogeneity within autism spectrum disorder in forensic mental health: the introduction of typologies. ADVANCES IN AUTISM 2016. [DOI: 10.1108/aia-08-2016-0021] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
Individuals with diagnoses of autism spectrum disorder (ASD) within criminal justice settings are a highly heterogeneous group. Although studies have examined differences between those with and without ASD in such settings, there has been no examination of differences within the ASD group. The paper aims to discuss these issues.
Design/methodology/approach
Drawing on the findings of a service evaluation project, this paper introduces a typology of ASD within forensic mental health and intellectual disability settings.
Findings
The eight subtypes that are described draw on clinical variables including psychopathy, psychosis and intensity/frequency of problem behaviours that co-occur with the ASD. The initial assessment of inter-rater reliability on the current version of the typology revealed excellent agreement, multirater Kfree =0.90.
Practical implications
The proposed typology could improve understanding of the relationship between ASD and forensic risk, identify the most appropriate interventions and provide prognostic information about length of stay. Further research to refine and validate the typology is ongoing.
Originality/value
This paper introduces a novel, typology-based approach which aims to better serve people with ASD within criminal justice settings.
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Margoni F, Surian L. Mental State Understanding and Moral Judgment in Children with Autistic Spectrum Disorder. Front Psychol 2016; 7:1478. [PMID: 27729894 PMCID: PMC5037184 DOI: 10.3389/fpsyg.2016.01478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022] Open
Affiliation(s)
- Francesco Margoni
- Department of Psychology and Cognitive Sciences, University of Trento Rovereto, Italy
| | - Luca Surian
- Department of Psychology and Cognitive Sciences, University of Trento Rovereto, Italy
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Baez S, Kanske P, Matallana D, Montañes P, Reyes P, Slachevsky A, Matus C, Vigliecca NS, Torralva T, Manes F, Ibanez A. Integration of Intention and Outcome for Moral Judgment in Frontotemporal Dementia: Brain Structural Signatures. NEURODEGENER DIS 2016; 16:206-17. [DOI: 10.1159/000441918] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 10/22/2015] [Indexed: 11/19/2022] Open
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Associations between high callous-unemotional traits and quality of life across youths with non-conduct disorder diagnoses. Eur Child Adolesc Psychiatry 2016; 25:547-55. [PMID: 26362863 PMCID: PMC4854931 DOI: 10.1007/s00787-015-0766-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 08/27/2015] [Indexed: 02/01/2023]
Abstract
Research regarding callous-unemotional (CU) traits in non-conduct disorder (CD) diagnoses is sparse. We investigated the presence of high CU traits and their associations with quality of life (QoL) in a clinically referred sample of youths with non-CD diagnoses. Parents of 1018 children referred to a child and adolescent psychiatric clinic and rated their child's CU traits and QoL. Experienced clinicians derived DSM-IV-TR diagnoses based on systematic clinical evaluations of these children. High CU traits compared to low CU traits were present in 38.5 % of the sample, and more often in boys than girls (69.4 vs. 30.6 %, p = .004), and were associated with more police contacts (12.2 vs. 3.5 %, p < .001). Logistic regression analyses revealed that those with diagnoses of autism spectrum disorder (odds ratio; OR = 1.61; 95 % CI 1.24-2.09; p < .001) and disruptive behavior disorder not otherwise specified/oppositional defiant disorder (OR = 4.98; 95 % CI 2.93-8.64; p < .001), but not attention-deficit/hyperactivity disorder (OR = 1.01; 95 % CI .79-1.31; p = .94), were more likely to have high than low CU traits. Those with anxiety/mood disorders were more likely to have low than high CU traits (OR = .59; 95 % CI .42-82; p = .002). In all diagnostic groups, high CU compared to low CU traits were associated with significantly lower QoL, while controlling for gender, age, and comorbidity. As such, high CU traits significantly modify QoL in non-CD disorders.
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Carter Leno V, Naples A, Cox A, Rutherford H, McPartland JC. Common and distinct modulation of electrophysiological indices of feedback processing by autistic and psychopathic traits. Soc Neurosci 2015; 11:455-66. [PMID: 26471250 DOI: 10.1080/17470919.2015.1108223] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Both autism spectrum disorder (ASD) and psychopathy are primarily characterized by social dysfunction; overlapping phenotypic features may reflect altered function in common brain mechanisms. The current study examined the degree to which neural response to social and nonsocial feedback is modulated by autistic versus psychopathic traits in a sample of typically developing adults (N = 31, 11 males, 18-52 years). Event-related potentials were recorded whilst participants completed a behavioral task and received feedback on task performance. Both autistic and psychopathic traits were associated with alterations in the neural correlates of feedback processing. Sensitivity to specific forms of feedback (social, nonsocial, positively valenced, negatively valenced) differed between the two traits. Autistic traits were associated with decreased sensitivity to social feedback. In contrast, the antisocial domain of psychopathic traits was associated with an overall decrease in sensitivity to feedback, and the interpersonal manipulation domain was associated with preserved processing of positively valenced feedback. Results suggest distinct alterations within specific mechanisms of feedback processing may underlie similar difficulties in social behavior.
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Affiliation(s)
| | - Adam Naples
- a Yale School of Medicine , Child Study Center , New Haven , CT , USA
| | - Anthony Cox
- a Yale School of Medicine , Child Study Center , New Haven , CT , USA
| | - Helena Rutherford
- a Yale School of Medicine , Child Study Center , New Haven , CT , USA
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Lai MC, Baron-Cohen S. Identifying the lost generation of adults with autism spectrum conditions. Lancet Psychiatry 2015; 2:1013-27. [PMID: 26544750 DOI: 10.1016/s2215-0366(15)00277-1] [Citation(s) in RCA: 333] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/06/2015] [Accepted: 06/08/2015] [Indexed: 12/13/2022]
Abstract
Autism spectrum conditions comprise a set of early-onset neurodevelopmental syndromes with a prevalence of 1% across all ages. First diagnosis in adulthood has finally become recognised as an important clinical issue due to the increasing awareness of autism, broadening of diagnostic criteria, and the introduction of the spectrum concept. Thus, the idea of a lost generation of people who were previously excluded from a diagnosis of classic autism has arisen. Making a first diagnosis of autism spectrum conditions in adults can be challenging for practical reasons (eg, no person to provide a developmental history), developmental reasons (eg, the acquisition of learnt or camouflaging strategies), and clinical reasons (eg, high frequency of co-occurring disorders). The diagnostic process includes referral, screening, interviews with informants and patients, and functional assessments. In delineating differential diagnoses, true comorbidities, and overlapping behaviour with other psychiatric diagnoses, particular attention should be paid to anxiety, depression, obsessive-compulsive disorder, psychosis, personality disorders, and other neurodevelopmental disorders. Possible misdiagnosis, especially in women, should be explored. The creation of supportive, accepting, and autism-friendly social and physical environments is important and requires a coordinated effort across agencies and needs support from government policies.
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Affiliation(s)
- Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK; Centre for Addiction and Mental Health, The Hospital for Sick Children, and Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK; Cambridge Lifespan Asperger Syndrome Service (CLASS) Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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Leno VC, Charman T, Pickles A, Jones CRG, Baird G, Happé F, Simonoff E. Callous-unemotional traits in adolescents with autism spectrum disorder. Br J Psychiatry 2015; 207:392-9. [PMID: 26382954 PMCID: PMC4629071 DOI: 10.1192/bjp.bp.114.159863] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/16/2014] [Indexed: 12/04/2022]
Abstract
BACKGROUND People with callous-unemotional traits and also those with autism spectrum disorder (ASD) display sociocognitive difficulties. However, the frequency and neurocognitive correlates of callous-unemotional traits within individuals with ASD are unknown. AIMS To determine the prevalence of callous-unemotional traits in individuals with ASD and test their association with behavioural and cognitive measures. METHOD Parents of 92 adolescents with ASD completed the Antisocial Processes Screening Device (APSD) for callous-unemotional traits. Adolescents participated in tasks of emotion recognition, theory of mind and cognitive flexibility. RESULTS In total 51% (n = 47) scored above a cut-off expected to identify the top 6% on the APSD. Of these 17% (n = 8) had concurrent conduct problems. Regression analyses found callous-unemotional traits were associated with specific impairment in fear recognition but not with theory of mind or cognitive flexibility. CONCLUSIONS Adolescents with ASD show high rates of callous-unemotional traits but, unlike in the general population, these are not strongly associated with conduct problems. The relationship of callous-unemotional traits to impairments in fear recognition suggests similar affective difficulties as in individuals with callous-unemotional traits without ASD.
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Affiliation(s)
- Virginia Carter Leno
- Correspondence: Virginia Carter Leno, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AF.
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Examining the Genetic and Environmental Associations between Autistic Social and Communication Deficits and Psychopathic Callous-Unemotional Traits. PLoS One 2015; 10:e0134331. [PMID: 26325039 PMCID: PMC4556482 DOI: 10.1371/journal.pone.0134331] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 07/09/2015] [Indexed: 11/23/2022] Open
Abstract
Background Difficulties in appropriate social interaction are characteristic of both children with autism spectrum disorders and children with callous-unemotional traits (who are at risk of developing psychopathy). Extant experimental studies suggest that the nature of atypical social cognition that characterises these two profiles is not identical. However, ‘empathizing’ difficulties have been hypothesised for both groups, raising questions about the degree of aetiological separation between social impairments that characterize each disorder. This study explored the relative contribution of independent vs. shared aetiological influences to social and communication impairments associated with autistic traits and callous-unemotional traits, indexed by parent-report in a population-based cohort of twins. Methods Participants were over 5,000 twin pairs from a UK cohort (the Twins Early Development Study; TEDS), assessed for callous-unemotional traits at 7 years and autistic social and communication impairments at 8 years. Multivariate model-fitting was used to explore the relative contribution of independent vs. overlapping genetic/environmental influences on these traits. Results Both social and communication impairments and callous-unemotional traits were highly heritable, although the genetic and environmental influences accounting for individual differences on each domain were predominantly independent. Conclusions Extant evidence from experimental and neuro-imaging studies has suggested that, despite some superficially overlapping behaviours, the social difficulties seen in children with autism spectrum disorders and callous-unemotional traits are largely distinct. The current study is the first to demonstrate considerable aetiological independence of the social interaction difficulties seen in children with autism spectrum disorders and those with callous-unemotional traits.
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Gillberg C, Gillberg IC, Thompson L, Biskupsto R, Billstedt E. Extreme ("pathological") demand avoidance in autism: a general population study in the Faroe Islands. Eur Child Adolesc Psychiatry 2015; 24:979-84. [PMID: 25398390 DOI: 10.1007/s00787-014-0647-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 11/05/2014] [Indexed: 11/30/2022]
Abstract
Research into Pathological Demand Avoidance (PDA), which has been suggested to be a subgroup within the Autism Spectrum Disorder (ASD), is almost nonexistent in spite of the frequent reference to the condition in clinical practice. The total population of 15 to 24-year-olds in the Faroe Islands was screened for ASD, and 67 individuals were identified who met diagnostic criteria for ASD (corresponding to a general population prevalence of ASD of almost 1 %). Of these 67, 50 had parents who were interviewed using the Diagnostic Interview for Social and Communication Disorders (DISCO-11) which contains 15 "PDA-specific" items. Nine individuals met criteria for "possible clinical diagnosis of PDA", meaning that almost one in five of all with ASD also had indications of having had PDA in childhood, and that 0.18 % of the total population had had the combination of ASD and PDA. However, at the time of assessment, only one of the 9 individuals with possible PDA still met "full criteria". PDA possibly constitutes a considerable minority of all cases with ASD diagnosed in childhood, but criteria for the condition are unlikely to be still met in later adolescence and early adult life.
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Affiliation(s)
- Christopher Gillberg
- Gillberg Neuropsychiatry Centre (GNC), Sahlgrenska Academy, University of Gothenburg, Kungsgatan 12, 411 19, Gothenburg, Sweden,
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