Autism: towards an integration of clinical, genetic, neuropsychological, and neurobiological perspectives

Representations of adult attachment and shame in parents of children on the autism spectrum

Social communication disabilities in children on the autism spectrum challenge parenting. This is the first study to examine mental representations of adult attachment and shame in parents of children on the autism spectrum. Thirty-seven parents of children diagnosed with autism spectrum disorder (mean age 5.17 years) from middle to high-income households participated in the study. The Adult Attachment Projective Picture System was used to evaluate adult attachment patterns and representations as well as shame outcomes. All but three parents were classified as having insecure adult attachments. Almost half of the participants (45.9%) were classified as having unresolved attachments. All parents showed representations of a shamed self. Deep shame associated with attachment trauma was more common than normative shame. The sample was divided into regulated (secure, dismissing, and preoccupied combined) versus unresolved individuals. There were no significant group differences regarding shame or shame outcomes. The discussion addresses how the high frequency of insecure attachment representations and shame may affect parenting. This prevalence suggests that clinicians support families with children on the autism spectrum and introduce the topic of shame.

Structural pathways related to the subventricular zone are decreased in volume with altered microstructure in young adult males with autism spectrum disorder

Autism spectrum disorder is a neurodevelopmental condition characterized by reduced social communication and repetitive behaviors. Altered neurogenesis, including disturbed neuronal migration, has been implicated in autism spectrum disorder. Using diffusion MRI, we previously identified neuronal migration pathways in the human fetal brain and hypothesized that similar pathways persist into adulthood, with differences in volume and microstructural characteristics between individuals with autism spectrum disorder and controls. We analyzed diffusion MRI-based tractography of subventricular zone-related pathways in 15 young adult men with autism spectrum disorder and 18 controls at Massachusetts General Hospital, with validation through the Autism Imaging Data Exchange II dataset. Participants with autism spectrum disorder had reduced subventricular zone pathway volumes and fractional anisotropy compared to controls. Furthermore, subventricular zone pathway volume was positively correlated (r: 0.68; 95% CI: 0.25 to 0.88) with symptom severity, suggesting that individuals with more severe symptoms tended to have larger subventricular zone pathway volumes, normalized by brain size. Analysis of the Autism Imaging Data Exchange cohort confirmed these findings of reduced subventricular zone pathway volumes in autism spectrum disorder. While some of these pathways may potentially include inaccurately disconnected pathways that go through the subventricular zone, our results suggest that diffusion MRI-based tractography pathways anatomically linked to the periventricular region are associated with certain symptom types in adult males with autism spectrum disorder.

Knowledge and practice among caregivers having children with autism in Bangladesh: findings from a cross-sectional study

BACKGROUND

Autism spectrum disorder (ASD) is a term used to describe a group of conditions characterized by difficulties with social skills, speech, repetitive behaviors, and nonverbal communication. There is no cure for autism, however, early diagnosis and intervention can increase the chance of treatment success. If parents or caregivers do not have sound knowledge about autism, problems can become more complicated. The study aimed to assess the knowledge and practice among caregivers having children with ASD in Bangladesh.

METHODS

A cross-sectional survey was conducted among 68 caregivers of children with ASD in the selected area of Mymensingh city, Bangladesh. The data were collected from May to June 2021 through face-to-face interviews by a semi-structured questionnaire including informed consent, socio-demographics, as well as questions regarding knowledge (12-item) and practice (6-item) towards children with ASD using a purposive sampling technique. The data were analyzed using the SPSS software (version 25.0).

RESULTS

The mean score of knowledge among caregivers having children with ASD was 7.16 (SD = 2.09) out of 12 (59.67%). The mean score of practice among caregivers having children with ASD was 3.16 (SD = 1.10) out of 6 (52.67%). There were no significant mean differences in the mean knowledge and practice scores among participants' different socio-demographic categories. 95.6% of caregivers have not received any formal training to care for children with ASD, and more than half (57.4%) believed that mixing with good friends would make the necessary change in children with ASD. 97.1% of the children with ASD did not have any health insurance with 72.1% receiving government allowance for ASD.

CONCLUSIONS

The findings indicated inadequate knowledge and practice among caregivers of children with ASD. The study suggests an immediate health education program is needed, as well as appropriate practice for children with ASD in Bangladesh.

How (and why) languages became more complex as we evolved more prosocial: the human self-domestication view

This paper aims to re-examine the problem of the emergence of present-day languages from the specific perspective of the self-domestication account of human evolution. According to this view, our species went through an evolutionary process that parallels the changes experienced by domesticated mammals. Relying on evidence of diverse kind (from paleogenetic to clinical), the paper argues that our self-domestication might have potentiated the cognitive and behavioral features of the human phenotype with an impact on language acquisition and use. Specifically, it might have facilitated the creation of the cultural niche that favors the complexification of languages via a cultural mechanism. The paper further proposes a model of language complexification in the past under the effects of human self-domestication, including the complexification of the structural aspects of language (grammar, prosody, and semantics) and the potentiation of its functional properties (pragmatics). The paper concludes with some suggestions for any future research aimed to test and improve this view.

Valproic Acid in Pregnancy Revisited: Neurobehavioral, Biochemical and Molecular Changes Affecting the Embryo and Fetus in Humans and in Animals: A Narrative Review

Valproic acid (VPA) is a very effective anticonvulsant and mood stabilizer with relatively few side effects. Being an epigenetic modulator, it undergoes clinical trials for the treatment of advanced prostatic and breast cancer. However, in pregnancy, it seems to be the most teratogenic antiepileptic drug. Among the proven effects are congenital malformations in about 10%. The more common congenital malformations are neural tube defects, cardiac anomalies, urogenital malformations including hypospadias, skeletal malformations and orofacial clefts. These effects are dose related; daily doses below 600 mg have a limited teratogenic potential. VPA, when added to other anti-seizure medications, increases the malformations rate. It induces malformations even when taken for indications other than epilepsy, adding to the data that epilepsy is not responsible for the teratogenic effects. VPA increases the rate of neurodevelopmental problems causing reduced cognitive abilities and language impairment. It also increases the prevalence of specific neurodevelopmental syndromes like autism (ASD) and Attention Deficit Hyperactivity Disorder (ADHD). High doses of folic acid administered prior to and during pregnancy might alleviate some of the teratogenic effect of VPA and other AEDs. Several teratogenic mechanisms are proposed for VPA, but the most important mechanisms seem to be its effects on the metabolism of folate, SAMe and histones, thus affecting DNA methylation. VPA crosses the human placenta and was found at higher concentrations in fetal blood. Its concentrations in milk are low, therefore nursing is permitted. Animal studies generally recapitulate human data.

Increased vigorous exercise and decreased sedentary activities are associated with decreased depressive symptoms in United States adults: Analysis of The National Health and Nutrition Examination Survey (NHANES) 2017-2020

Background and aims

Depression is a major public health concern that affects over 4% of the global population. Identification of new nonpharmacologic recommendations will help decrease the burden of disease. The overarching of this study was to examine the association between physical activity and depressive symptoms in a large sample of adults in the United States.

Methods

Presently, researchers utilized data from the National Health and Nutrition Examination Surveys (NHANES 2017-2020), which is a retrospective, complex, multistage, representative, and modern cohort of the United States. Adult patients ( > 18 years; N = 8091) with complete 9-item Patient Health Questionnaire (PHQ-9) information were included in the study. The PHQ-9 is a well-validated survey, per literature, scores ≥10 are considered to have clinically relevant depression. Univariable and multivariable logistic regression was fit for active and sedentary activities on clinical depression (PHQ-9 ≥ 10). The acquisition and analysis of the data within this study were approved by the National Center for Health Statistics Ethics Review Board.

Results

After adjusting for potential confounders like age, race, sex, and income, we found that increased vigorous exercise was associated with lower rates of depressive symptoms. Each extra day of vigorous exercise was associated with 11% decreased odds of depression (odd ratio [OR]: 0.89, confidence interval [CI]: 0.83-0.96, p < 0.01). Increased sedentary activity was associated with increased depression. Each extra hour per day of sedentary activity was associated with a 6% increase in odds of depression (OR: 1.06, (1.02-1.10, p < 0.01).

Conclusion

To conclude, exercise appears to be protective against depressive symptoms; however, further prospective studies are required to ascertain whether exercise causes decreased depressive symptoms.

An evolutionary account of impairment of self in cognitive disorders

Recent research has proposed that certain aspects of psychosis, as experienced in, e.g., schizophrenia (SCZ), but also aspects of other cognitive conditions, such as autism spectrum disorders (ASD) and synesthesia, can be related to a shattered sense of the notion of self. In this paper, our goal is to show that altered processing of self can be attributed to an abnormal functioning of cortico-striatal brain networks supporting, among other, one key human distinctive cognitive ability, namely cross-modality, which plays multiple roles in human cognition and language. Specifically, our hypothesis is that this cognitive mechanism sheds light both on some basic aspects of the minimal self and on some aspects related to higher forms of self, such as the narrative self. We further link the atypical functioning in these conditions to some recent evolutionary changes in our species, specifically, an atypical presentation of human self-domestication (HSD) features. In doing so, we also lean on previous work concerning the link between cognitive disorders and language evolution under the effects of HSD. We further show that this approach can unify both linguistic and non-linguistic symptoms of these conditions through deficits in the notion of self. Our considerations provide further support for the hypothesis that SCZ and ASD are diametrically opposed cognitive conditions, as well for the hypothesis that their etiology is associated with recent human evolution, leading to a deeper understanding of the causes and symptoms of these disorders, and providing new cues, which can be used for an earlier and more accurate diagnostics.

Improvement of the Clinical and Psychological Profile of Patients with Autism after Methylcobalamin Syrup Administration

(1) Background: Autism, also known as autism-spectrum disorder, is a pervasive developmental disorder affecting social skills and psychological status in particular. The complex etiopathogenesis of autism limits efficient therapy, which leads to problems with the normal social integration of the individual and causes severe family distress. Injectable methylcobalamin was shown to improve the clinical status of patients via enhanced cell oxidative status and/or methylation capacity. Here we tested the efficiency of a syrup form of methylcobalamin in treating autism. (2) Methods: Methylcobalamin was administered daily at 500 µg dose to autistic children and young adults (n = 25) during a 200-day period. Clinical and psychological status was evaluated by parents and psychologists and plasma levels of reduced and oxidized glutathione, vitamin B12, homocysteine, and cysteine were determined before the treatment, and at day 100 and day 200 of the treatment. (3) Results: Good patient compliance was reported. Methylcobalamin treatment gradually improved the overall clinical and psychological status, with the highest impact in the social domain, followed by the cognitive, behavioral and communication characteristics. Changes in the clinical and psychological status were strongly associated with the changes in the level of reduced glutathione and reduced/oxidized glutathione ratio. (4) Conclusion: A high dose of methylcobalamin administered in syrup form ameliorates the clinical and psychological status of autistic individuals, probably due to the improved oxidative status.

Developmental disabilities across the world: A scientometric review from 1936 to 2020

BACKGROUND

Developmental disabilities have been largely studied in the past years. Their etiological mechanisms have been underpinned to the interactions between genetic and environmental factors. These factors show variability across the world. Thus, it is important to understand where the set of knowledge obtained on developmental disabilities originates from and whether it is generalizable to low- and middle-income countries.

AIMS

This study aims to understand the origins of the available literature on developmental disabilities, keeping a focus on parenting, and identify the main trend of research.

METHODS AND PROCEDURE

A sample of 11,315 publications from 1936 to 2020 were collected from Scopus and a graphical country analysis was conducted. Furthermore, a qualitative approach enabled the clustering of references by keywords into four main areas: "Expression of the disorder", "Physiological Factors", "How it is studied" and "Environmental factors". For each area, a document co-citation analysis (DCA) on CiteSpace software was performed.

OUTCOMES AND RESULTS

Results highlight the leading role of North America in the study of developmental disabilities. Trends in the literature and the documents' scientific relevance are discussed in details.

CONCLUSIONS AND IMPLICATIONS

Results demand for investigation in different socio-economical settings to generalize our knowledge. What this paper adds? The current paper tries to provide insight into the origins of the literature on developmental disabilities with a focus on parenting, together with an analysis of the trends of research in the field. The paper consisted of a multi-disciplinary and multi-method review. In fact, the review tried to integrate the analysis of the relation between developmental disabilities with a closer look at the scientific contributions to the field across the world. Specifically, the paper integrates a total of 11,315 papers published on almost a century of research (from 1936 to 2020). An initial qualitative analysis on keywords was combined to a subsequent quantitative approach in order to maximize the comprehension of the impact of almost a century of scientific contributions. Specifically, documents were studied with temporal and structural metrics on a scientometric approach. This allowed the exploration of patterns within the literature available on Scopus in a quantitative way. This method not only assessed the importance of single documents within the network. As a matter of fact, the document co-citation analysis used on CiteSpace software provided insight into the relations existing between multiple documents in the field of research. As a result, the leading role of North America in the literature of developmental disabilities and parenting emerged. This was accompanied by the review of the main trends of research within the existing literature.

Prevalence of epilepsy in autism spectrum disorders: A systematic review and meta-analysis

LAY ABSTRACT

Autistic individuals experience higher co-occurring medical conditions than the general population, and yet the estimates of autistic individuals with epilepsy are not updated. Co-occurrence of epilepsy in autistic individuals often aggravated cognitive impairment and increased the risk of poor long-term prognosis. Thus, an updated systematic review and meta-analysis was conducted to study the relevant articles published from inception to 2020, evaluate the prevalence of epilepsy in autistic individuals, and further explore the putative factors influencing the prevalence. A total of 66 studies from 53 articles were included in this study. The results showed that epilepsy is more common in autistic individuals than in the general population. The prevalence of epilepsy in autistic individuals in the clinical sample-based studies was higher than that in the population-based based cross-sectional or cohort studies. The prevalence of epilepsy in autistic adults was higher than that in autistic children. A significantly increased prevalence of epilepsy was detected in the autistic adolescent group (11-17 years old), and a higher trend of prevalence of epilepsy was observed in the autistic pre-school group (⩽ 6 -years-old) than that of the autistic school-aged group (7-10 years-old). The prevalence of epilepsy increased with age, female rate, and low intellectual function rate of autistic individuals. However, the human development index of countries was negatively associated with the pooled prevalence, which could be attributed to the different levels of awareness, diagnostic technologies, and autism-service support worldwide. About 1/10 autistic individuals also had epilepsy, which was common in the clinical setting, adolescents, adults, females, or patients with intellectual disability and less common in the country with high human development index. Thus, these findings provided critical and innovative views on the prevalence of epilepsy in autistic individuals and contributed to the targeted clinical management and preventive measures.

Human Self-Domestication and the Evolution of Pragmatics

As proposed for the emergence of modern languages, we argue that modern uses of languages (pragmatics) also evolved gradually in our species under the effects of human self-domestication, with three key aspects involved in a complex feedback loop: (a) a reduction in reactive aggression, (b) the sophistication of language structure (with emerging grammars initially facilitating the transition from physical aggression to verbal aggression); and (c) the potentiation of pragmatic principles governing conversation, including, but not limited to, turn-taking and inferential abilities. Our core hypothesis is that the reduction in reactive aggression, one of the key factors in self-domestication processes, enabled us to fully exploit our cognitive and interactional potential as applied to linguistic exchanges, and ultimately to evolve a specific form of communication governed by persuasive reciprocity-a trait of human conversation characterized by both competition and cooperation. In turn, both early crude forms of language, well suited for verbal aggression/insult, and later more sophisticated forms of language, well suited for persuasive reciprocity, significantly contributed to the resolution and reduction of (physical) aggression, thus having a return effect on the self-domestication processes. Supporting evidence for our proposal, as well as grounds for further testing, comes mainly from the consideration of cognitive disorders, which typically simultaneously present abnormal features of self-domestication (including aggressive behavior) and problems with pragmatics and social functioning. While various approaches to language evolution typically reduce it to a single factor, our approach considers language evolution as a multifactorial process, with each player acting upon the other, engaging in an intense mutually reinforcing feedback loop. Moreover, we see language evolution as a gradual process, continuous with the pre-linguistic cognitive abilities, which were engaged in a positive feedback loop with linguistic innovations, and where gene-culture co-evolution and cultural niche construction were the main driving forces.

Gluten and FODMAPs Relationship with Mental Disorders: Systematic Review

Nowadays, gluten and FODMAP food components (fermentable oligosaccharides, disaccharides, monosaccharides and polyols) are increasingly studied due to their possible relation with extraintestinal-associated conditions. In recent years, gluten-free diets (GFD) and low-FODMAP diets (LFD) are becoming more popular not only in order to avoid the food components that cause intolerances or allergies in some people, but also due to the direct influence of marketing movements or diet trends on feeding habits. Likewise, neurological and psychiatric diseases are currently of increasing importance in developed countries. For this reason, a bibliographic systematic review has been carried out to analyse whether there is a pathophysiological relationship between the dietary intake of gluten or FODMAPs with mental disorders. This review collects 13 clinical and randomized controlled trials, based on the PRISMA statement, which have been published in the last ten years. Based on these results, limiting or ruling out gluten or FODMAPs in the diet might be beneficial for symptoms such as depression, anxiety (7 out of 7 articles found any positive effect), or cognition deficiency (improvements in several cognition test measurements in one trial), and to a lesser extent for schizophrenia and the autism spectrum. Nevertheless, further studies are needed to obtain completely reliable conclusions.

The Association between Labor Induction and Autism Spectrum Disorders Among Children: A Meta-Analysis

BACKGROUND

It was hypothesized that the oxytocin used during labor could increase the risk of neurodevelopmental disorders, such as ASD.

OBJECTIVE

This meta-analysis pooled all observational studies to obtain the association between labor induction and the risk of ASD among children. We identified all published studies up to August 2020 by search in PubMed, Scopus, Web of Science and gray literature. The pooled odds ratios (OR), relative ratio (RR) and 95% confidence intervals (CI (were calculated as random effect estimates of association among studies.

RESULTS

The pooled estimates of OR and RR reported a significant association between labor induction and ASD among children, respectively (OR = 1.09, 95% CI = 1.04 to 1.15) and (RR = 1.06, 95% CI = 1.02 to 1.09). The subgroup analyses were performed based on the adjusted form and design of studies. OR in crude and adjusted studies were reported to be 1.25(1.01, 1.49) and 1.08(1.02, 1.14), respectively. A significant association was found in adjusted and crude studies. There is no significant association between labor induction and ASD in case-control studies (OR=1.08, 95% CI = 0.99, 1.17).

CONCLUSION

The findings showed that labor induction is associated with an increased risk of ASD among children. Therefore, the findings support that clinical use of oxytocin during labor has a significant negative impact on the long-term mental health of children.

The Relationship Between the Level of Copper, Lead, Mercury and Autism Disorders: A Meta-Analysis

BACKGROUND AND OBJECTIVES

There is a likelihood of a possible relationship between the concentrations of copper, lead, and mercury and autism. The present review was carried out to determine the relationship between the concentrations of these elements and autism by meta-analysis.

METHODS

In this study, searching Scopus, PubMed, and Science Direct databases, 18 articles conducted in different countries from 1982 to 2019 were collected. Studies' heterogeneity was investigated using the I2 index. The data were analyzed using R and STATA software.

RESULTS

In these 18 studies, 1797 patients (981 cases and 816 controls) aged 2 to 16 years were examined. Concentration of the samples (blood, hair, and nails) for both case and control groups was evaluated. There was no significant relationship between copper concentration and autism (SMD (95% CI): 0.02 (-1.16,1.20); I2=97.7%; P=0.972); there was a significant relationship between mercury concentration and autism (SMD (95% CI): 1.96 (0.56,3.35); I2=98.6%; P=0.006); there was also a significant relationship between lead concentration and autism (SMD (95% CI): 2.81 (1.64,3.98); I2=97.8%; P=0.000).

CONCLUSION

There is, nevertheless, a significant relationship between mercury concentration and autism. Thus, the concentration of mercury can be listed as a pathogenic cause (disease-causing) for autism.

Association between assisted reproductive technology and autism spectrum disorders in Iran: a case-control study

BACKGROUND

Autism spectrum disorder (ASD) is a neurodevelopmental disorder defined by impairments in social interaction and verbal and nonverbal communication.

PURPOSE

Determine the association between use of assisted reproduction technology (ART) and the risk of ASD among children.

METHODS

This case-control study included 300 participants (100 cases, 200 controls). The control group included women with a child aged 2-10 years without ASD, while the cases were women with a child aged 2-10 years with ASD. We used a researcher-made questionnaire. Data were analyzed using Stata ver. 14 at the 0.05 significance level.

RESULTS

In the univariate analysis, there was significant association between child sex, delivery mode, history of preterm delivery, history of using ART, and maternal age at child's birth and the risk of ASD. After the adjustment for other variables, this association was significant for male sex (2.66; 95% confidence interval [CI], 1.11-4.31; P=0.001) and history of using ART (4.03; 95% CI, 1.76-9.21; P=0.001). Therefore, after the adjustment for confounder variables, there was no significant association between ART and the risk of ASD among children (4.98; 95% CI, 0.91-27.30; P=0.065).

CONCLUSION

After the adjustment for other variables, risk factors for ASD were male sex and history preterm delivery. Thus, there was no significant association between ART and the risk of ASD among children.

Initial severity and efficacy of risperidone in autism: Results from the RUPP trial

Background

Risperidone is a common psychopharmacological treatment for irritability in autism spectrum disorder (ASD). It is not well-established how effective risperidone is across the initial symptom severity range. This study aims to examine the influence of baseline severity on the efficacy of risperidone in the treatment of ASD.

Methods

Participants were from the NIMH funded RUPP multisite, randomized, double-blind trial that compared risperidone to placebo to treat autistic disorder with severe tantrums, aggression, or self-injury. Participants were aged 5 to 17, and randomly assigned to risperidone (n = 49) or placebo (n = 52). Baseline and change scores were computed with the Aberrant Behavior Checklist (ABC) parent assessed scales with irritability as the primary outcome, as well as the clinician assessed ABC Irritability subscale, and Clinical Global Impression Scale.

Results

The relationship between baseline severity and change scores for the risperdone and placebo groups was examined with eight competing three-level mixed-effects models for repeated measure models. Significant (P < 0.01) interactions between treatment and baseline severity were observed for parent ABC ratings of irritability and lethargy only. Greater magnitudes of the differences between risperidone and placebo were observed from moderate to very severe baseline severity on irritability and lethargy. Initial severity values over approximately 30 had a strong effect on symptom change [irritability: effect size (ES) = 1.9, number needed to treat (NNT) = 2, lethargy ES = 0.9, NNT = 5].

Conclusions

Parents may expect benefits of risperidone on irritability and lethargy with moderate to severe symptoms of ASD.

Trial registration

Registry name: ClinicalTrials.gov, trial identifier: NCT00005014, URL: http://www.clinicaltrials.gov/ct2/show/NCT00005014?term=NCT00005014&rank=1, registered on March 31, 2000.

Association between neonatal jaundice and autism spectrum disorders among children: a meta-analysis

Autism spectrum disorder is a common neurodevelopmental disorder with an unknown etiology. The correlation between neonatal jaundice and the risk of developing autism spectrum disorder was investigated previously. Some studies showed significant associations, whereas others demonstrated no association. In this meta-analysis, we pooled the results of observational studies to examine the association between neonatal jaundice and the risk of autism spectrum disorder among children. We identified all studies published through April 2018 by conducting a literature search using Web of Science, PubMed, and Scopus databases as well as the reference lists of the retrieved studies. The pooled odds ratios (ORs), rate ratio (RR), and their 95% confidence intervals (CIs) were calculated as random effect estimates of association among studies. We conducted a subgroup analysis to explore any potential sources of intergroup heterogeneity. The pooled estimates of OR and RR showed a considerable correlation between neonatal jaundice and ASD among children (OR, 1.35; 95% CI, 1.02-1.68) and (RR, 1.39; 95% CI, 1.05-1.74). A larger effect size was shown in the pooled estimated crude OR than in the adjusted OR (1.75 [0.96-2.54] vs. 1.19 [1.07-1.30]). This study showed that neonatal jaundice may be associated with ASD and may increase the risk of ASD among children.

Empirical Failures of the Claim That Autistic People Lack a Theory of Mind

The claim that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. This article (a) reviews empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks; (b) highlights original findings that have failed to replicate; (c) documents multiple instances in which the various theory-of-mind tasks fail to relate to each other and fail to account for autistic traits, social interaction, and empathy; (c) summarizes a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by researchers working inside the theory-of-mind rubric; and (d) concludes that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

The assertion that autistic people lack a theory of mind—that they fail to understand that other people have a mind or that they themselves have a mind—pervades psychology. In this article, we critically examine the empirical basis of this assertion. We review empirical evidence that fails to support the claim that autistic people are uniquely impaired, much less that all autistic people are universally impaired, on theory-of-mind tasks. We highlight seminal theory-of-mind findings that have failed to replicate. We document multiple instances in which the various theory-of-mind tasks fail to converge and fail to predict autistic traits, social interaction, and empathy. We summarize a large body of data, collected by researchers working outside the theory-of-mind rubric, that fails to support assertions made by researchers working inside the theory-of-mind rubric. We conclude that the claim that autistic people lack a theory of mind is empirically questionable and societally harmful.

Parents' Autistic Personality Traits and Sex-Biased Family Ratio Determine the Amount of Technical Toy Choice

We investigated the effect of parents' autism quotient (AQ), their sex and the sex of their children on their toy preference. In a computerized forced-choice shopping task, adults selected from cuddly and social role-playing toys (social toys), academic, music and sports toys (educational toys) and construction sets as well as cars (technical toys). A sex-balanced high and low AQ sample of 160 adults consisted of groups of parents of sons only, daughters only, sons and daughters, as well as of a group of adults without children (non-parents). The standard toy preference was social toys < educational toys < technical toys. Low AQ women were the only group to make a significantly higher amount of educational and a lower amount of technical toy choices. The mere presence of just sons increased technical toy choice in this experiment, while the mere presence of just daughters reduced technical toy choice both in men and high AQ individuals.

Solving for X: Evidence for sex-specific autism biomarkers across multiple transcriptomic studies

Autism spectrum disorder (ASD) is a markedly heterogeneous condition with a varied phenotypic presentation. Its high concordance among siblings, as well as its clear association with specific genetic disorders, both point to a strong genetic etiology. However, the molecular basis of ASD is still poorly understood, although recent studies point to the existence of sex-specific ASD pathophysiologies and biomarkers. Despite this, little is known about how exactly sex influences the gene expression signatures of ASD probands. In an effort to identify sex-dependent biomarkers and characterize their function, we present an analysis of a single paired-end postmortem brain RNA-Seq data set and a meta-analysis of six blood-based microarray data sets. Here, we identify several genes with sex-dependent dysregulation, and many more with sex-independent dysregulation. Moreover, through pathway analysis, we find that these sex-independent biomarkers have substantially different biological roles than the sex-dependent biomarkers, and that some of these pathways are ubiquitously dysregulated in both postmortem brain and blood. We conclude by synthesizing the discovered biomarker profiles with the extant literature, by highlighting the advantage of studying sex-specific dysregulation directly, and by making a call for new transcriptomic data that comprise large female cohorts.

Autism spectrum disorder: early identification and management in primary care

Autism spectrum disorder (ASD) is characterised by persistent deficits in social communication and interaction as well as restricted, repetitive patterns of behaviour and interests. Early detection and early intervention programmes improve functional outcomes. Family physicians should screen for ASD opportunistically when children attend clinics for acute issues and during scheduled well-child assessments. Early warning signs of ASD include the lack of social gestures at 12 months, using no meaningful single words at 18 months, and having no interest in other children or no spontaneous two-word phrases at 24 months. Children with suspected ASD should be referred to appropriate specialist centres as early as possible for multidisciplinary assessment and diagnosis.

Molecular Systems Biology of Neurodevelopmental Disorders, Rett Syndrome as an Archetype

Neurodevelopmental disorders represent a challenging biological and medical problem due to their genetic and phenotypic complexity. In many cases, we lack the comprehensive understanding of disease mechanisms necessary for targeted therapeutic development. One key component that could improve both mechanistic understanding and clinical trial design is reliable molecular biomarkers. Presently, no objective biological markers exist to evaluate most neurodevelopmental disorders. Here, we discuss how systems biology and "omic" approaches can address the mechanistic and biomarker limitations in these afflictions. We present heuristic principles for testing the potential of systems biology to identify mechanisms and biomarkers of disease in the example of Rett syndrome, a neurodevelopmental disorder caused by a well-defined monogenic defect in methyl-CpG-binding protein 2 (MECP2). We propose that such an approach can not only aid in monitoring clinical disease severity but also provide a measure of target engagement in clinical trials. By deepening our understanding of the "big picture" of systems biology, this approach could even help generate hypotheses for drug development programs, hopefully resulting in new treatments for these devastating conditions.

Parenting behavior and the development of children with autism spectrum disorder

Autism spectrum disorders (ASD) are neurodevelopmental disorders in which multiple genetic and environmental factors play roles. Symptoms of deficits in social communication and restrictive, repetitive behavioral patterns emerge early in a child's development. While parents do not cause these difficulties, impairments in social relatedness can strain parent child interactions and parental stress can have negative transactional effects that impede children development. Conversely, as with typically developing children, parental behavior can also enhance development in ASD and parents play a role in many interventions. In this review we examine parental contributions to the development of children with ASD, focusing on social communication and emotion regulation. We address parent and family characteristics that may impede development so they can be identified in families and interventions developed to target them.

The association between preeclampsia and autism spectrum disorders among children: a meta-analysis

Purpose

In this meta-analysis, relevant case-control and cohort studies were pooled to evaluate the association between preeclampsia and the risk of autism spectrum disorders (ASDs) in children.

Methods

A search for relevant studies in major databases, including Web of Science, PubMed, and Scopus, was performed up to May 2018. The odds ratios (ORs) or rate ratios (RRs) with 95% confidence intervals (CIs) were extracted from eligible studies to determine the association among studies.

Results

The pooled estimates of ORs and RRs indicated a significant association between preeclampsia and ASD [(OR, 1.36; 95% CI, 1.12–1.60) and (RR, 1.30; 95% CI, 1.20–1.41)].

Conclusions

Despite existing controversy, our findings indicated that preeclampsia was associated with an increased risk of ASD among children.

Maternal SSRIs experience and risk of ASD in offspring: a review

Antidepressants are extensively used during pregnancy and associated with severe outcomes, including innate malformations, prematurity, and low birth weight, etc. A recent study suggested that prenatal exposure to antidepressants may impair child neurodevelopment process. Thus, the aim of this review is to investigate the potential association between prenatal use of selective 5-HT reuptake inhibitors (SSRIs) and the risk of autism spectrum disorders (ASDs). Twelve studies related to the linkage between SSRI exposure during pregnancy and ASD in children were explored and compiled. However, there is a knowledge gap concerning the potential link between gestational exposure to antidepressants and the risk of ASDs. Despite such limitations, the available data show that some signal exists and signifies that antenatal exposure to SSRIs may increase the risk of ASDs. Thus, there is a vital need for further, large and well-designed research to definitively evaluate the existence and the magnitude of this severe risk.

Infertility treatments during pregnancy and the risk of autism spectrum disorder in the offspring

We aimed to examine the effects of infertility treatments on the risk of Autism Spectrum Disorder (ASD). Data were from a representative national registry on 110,093 male live births in Israel (born: 1999-2008; and ASD: 975, 0.9%). Infertility treatments included In Vitro Fertilization (IVF), and five hormone treatments. Relative risk (RR) was estimated with multivariable logistic models. Results showed that IVF treatment compared with spontaneous conception was not statistically significantly associated with the risk of ASD. Only progesterone hormone treatment was associated with a statistically significant (p < .05) increased risk of ASD (RR = 1.51, 95% CI 1.22, 1.86) compared to the group with no progesterone treatment. In conclusion, progesterone exposure during the critical period of fetal life elevated the risk of ASD, possibly reflecting epigenetic modification.

Stranger Fear and Early Risk for Social Anxiety in Preschoolers with Fragile X Syndrome Contrasted to Autism Spectrum Disorder

This study investigated behavioral indicators of social fear in preschool boys with fragile X syndrome (FXS) with a low degree of autism spectrum disorder (ASD) symptoms (FXS-Low; n = 29), FXS with elevated ASD symptoms (FXS-High; n = 25), idiopathic ASD (iASD; n = 11), and typical development (TD; n = 36). Gaze avoidance, escape behaviors, and facial fear during a stranger approach were coded. Boys with elevated ASD symptoms displayed more avoidant gaze, looking less at the stranger and parent than those with low ASD symptoms across etiologies. The iASD group displayed more facial fear than the other groups. Results suggest etiologically distinct behavioral patterns of social fear in preschoolers with elevated ASD symptoms.

Autism Diagnostic Observation Schedule (ADOS) scores in males and females diagnosed with autism: a naturalistic study

Purpose

Many tools are available for assessing autism in an adult population; however, few have been studied for the effects of gender on diagnostic scores. The purpose of this paper is to evaluate the Autism Diagnostic Observation Schedule (ADOS) assessment for gender bias in a clinical population, specifically whether the ADOS favours a “male-type” of autism.

Design/methodology/approach

The ADOS scores of patients referred to an NHS specialist autism assessment service were retrospectively examined for significant gender differences. The combined ADOS scores and diagnostic outcome were grouped by gender for each participant. The data were analysed in SPSS using independent t-tests to look for significant gender differences between combined ADOS scores and diagnostic outcomes.

Findings

A significant difference was observed in the mean combined ADOS scores for those participants who later received an autism diagnosis (male=10, female=6, t (13)=3.34, p=10; 0.005). However, no significant difference was observed between mean scores of those who did not receive an autism diagnosis (t (26)=1.21, p=0.237).

Originality/value

The ADOS is a popular assessment used for autism diagnosis. These results provide support for a male gender bias. This could have clinical implications for autism assessment services, whereby lower diagnostic thresholds could be considered for female patients. This could allow more females with autism to receive a diagnosis, and access support services.

Activities of Proline-Specific Proteinases in the Serum and Cerebrospinal Fluid of Rats with the Fetal Valproate Syndrome

In 60-day-old Wistar rats with fetal valproate syndrome, the brain to body weight ratio was higher by 9.4% and activity of dipeptidyl peptidase IV in the serum and cerebrospinal fluid was higher by 18.4 and 40.6%, respectively, than in healthy controls. Activity of prolylendopeptidase in the serum and cerebrospinal fluid in rats with the fetal valproate syndrome did not differ from the control.

INTERNEURONOPATHIES AND THEIR ROLE IN EARLY LIFE EPILEPSIES AND NEURODEVELOPMENTAL DISORDERS

GABAergic interneurons control the neural circuitry and network activity in the brain. The advances in genetics have identified genes that control the development, maturation and integration of GABAergic interneurons and implicated them in the pathogenesis of epileptic encephalopathies or neurodevelopmental disorders. For example, mutations of the Aristaless-Related homeobox X-linked gene (ARX) may result in defective GABAergic interneuronal migration in infants with epileptic encephalopathies like West syndrome (WS), Ohtahara syndrome or X-linked lissencephaly with abnormal genitalia (XLAG). The concept of "interneuronopathy", i.e. impaired development, migration or function of interneurons, has emerged as a possible etiopathogenic mechanism for epileptic encephalopathies. Treatments that enhance GABA levels, may help seizure control but do not necessarily show disease modifying effect. On the other hand, interneuronopathies can be seen in other conditions in which epilepsy may not be the primary manifestation, such as autism. In this review, we plan to outline briefly the current state of knowledge on the origin, development, and migration and integration of GABAergic interneurons, present neurodevelopmental conditions, with or without epilepsy, that have been associated with interneuronopathies and discuss the evidence linking certain types of interneuronal dysfunction with epilepsy and/or cognitive or behavioral deficits.

Neuroligin 3 R451C mutation alters electroencephalography spectral activity in an animal model of autism spectrum disorders

Human studies demonstrate that sleep impairment is a concurrent comorbidity of autism spectrum disorders (ASD), but its etiology remains largely uncertain. One of the prominent theories of ASD suggests that an imbalance in synaptic excitation/inhibition may contribute to various aspects of ASD, including sleep impairments. Following the identification of Nlgn3^R451C mutation in patients with ASD, its effects on synaptic transmission and social behaviours have been examined extensively in the mouse model. However, the contributory role of this mutation to sleep impairments in ASD remains unknown. In this study, we showed that Nlgn3^R451C knock-in mice, an established genetic model for ASD, exhibited normal duration and distribution of sleep/wake states but significantly altered electroencephalography (EEG) power spectral profiles for wake and sleep.

Language Impairments in ASD Resulting from a Failed Domestication of the Human Brain

Autism spectrum disorders (ASD) are pervasive neurodevelopmental disorders entailing social and cognitive deficits, including marked problems with language. Numerous genes have been associated with ASD, but it is unclear how language deficits arise from gene mutation or dysregulation. It is also unclear why ASD shows such high prevalence within human populations. Interestingly, the emergence of a modern faculty of language has been hypothesized to be linked to changes in the human brain/skull, but also to the process of self-domestication of the human species. It is our intention to show that people with ASD exhibit less marked domesticated traits at the morphological, physiological, and behavioral levels. We also discuss many ASD candidates represented among the genes known to be involved in the “domestication syndrome” (the constellation of traits exhibited by domesticated mammals, which seemingly results from the hypofunction of the neural crest) and among the set of genes involved in language function closely connected to them. Moreover, many of these genes show altered expression profiles in the brain of autists. In addition, some candidates for domestication and language-readiness show the same expression profile in people with ASD and chimps in different brain areas involved in language processing. Similarities regarding the brain oscillatory behavior of these areas can be expected too. We conclude that ASD may represent an abnormal ontogenetic itinerary for the human faculty of language resulting in part from changes in genes important for the “domestication syndrome” and, ultimately, from the normal functioning of the neural crest.

Genome-wide characteristics of de novo mutations in autism

De novo mutations (DNMs) are important in Autism Spectrum Disorder (ASD), but so far analyses have mainly been on the ~1.5% of the genome encoding genes. Here, we performed whole genome sequencing (WGS) of 200 ASD parent-child trios and characterized germline and somatic DNMs. We confirmed that the majority of germline DNMs (75.6%) originated from the father, and these increased significantly with paternal age only (p=4.2×10^-10). However, when clustered DNMs (those within 20kb) were found in ASD, not only did they mostly originate from the mother (p=7.7×10^-13), but they could also be found adjacent to de novo copy number variations (CNVs) where the mutation rate was significantly elevated (p=2.4×10^-24). By comparing DNMs detected in controls, we found a significant enrichment of predicted damaging DNMs in ASD cases (p=8.0×10^-9; OR=1.84), of which 15.6% (p=4.3×10^-3) and 22.5% (p=7.0×10^-5) were in the non-coding or genic non-coding, respectively. The non-coding elements most enriched for DNM were untranslated regions of genes, boundaries involved in exon-skipping and DNase I hypersensitive regions. Using microarrays and a novel outlier detection test, we also found aberrant methylation profiles in 2/185 (1.1%) of ASD cases. These same individuals carried independently identified DNMs in the ASD risk- and epigenetic- genes DNMT3A and ADNP. Our data begins to characterize different genome-wide DNMs, and highlight the contribution of non-coding variants, to the etiology of ASD.

Language deficits in schizophrenia and autism as related oscillatory connectomopathies: An evolutionary account

Schizophrenia (SZ) and autism spectrum disorders (ASD) are characterised by marked language deficits, but it is not clear how these arise from gene mutations associated with the disorders. Our goal is to narrow the gap between SZ and ASD and, ultimately, give support to the view that they represent abnormal (but related) ontogenetic itineraries for the human faculty of language. We will focus on the distinctive oscillatory profiles of the SZ and ASD brains, in turn using these insights to refine our understanding of how the brain implements linguistic computations by exploring a novel model of linguistic feature-set composition. We will argue that brain rhythms constitute the best route to interpreting language deficits in both conditions and mapping them to neural dysfunction and risk alleles of the genes. Importantly, candidate genes for SZ and ASD are overrepresented among the gene sets believed to be important for language evolution. This translational effort may help develop an understanding of the aetiology of SZ and ASD and their high prevalence among modern populations.

The Underlying Structures of Autism: An Exploratory Factor Analytic Study

Data from several psychometric variables was collected for 24 autistic children from a multidisciplinary center in Calgary, Alberta. The purpose of this study was to explore the underlying nature of autism. Variables were factor and duster analyzed to discover underlying structures of the disorder and to empirically derive homogeneous subtypes of children with a diagnosis of autism. Factor analysis indicated a 4 factor solution to account for the variance among variables. The groups were subsequently labeled Social Cognition, Language, Deviant Behavior, and Developmental. The clustering solution indicated the presence of two distinct groups labeled Low Functioning and High Functioning. Validity checks confirmed significance between group differences on measures of overall development, socinl functioning, and behaviors. The potential utility of empirical research is discussed along with limitations of the present study and suggestions for future research.

Clinical and Molecular Assessment in a Female with Fragile X Syndrome and Tuberous Sclerosis

OBJECTIVE

Fragile X syndrome (FXS) and tuberous sclerosis (TSC) are genetic disorders that result in intellectual disability and an increased prevalence of autism spectrum disorders (ASD). While the clinical presentation of each disorder is distinct, the molecular causes are linked to a disruption in the mTORC1 (mammalian Target of Rapamycin Complex 1) and ERK1/2 (Extracellular signal-Regulated Kinase) signaling pathways.

METHODS

We assessed the clinical and molecular characteristics of an individual seen at the UC Davis MIND Institute with a diagnosis of FXS and TSC. Clinical evaluation of physical, behavioral, and cognitive impairments were performed. Additionally, total and phosphorylated proteins along the mTORC1 and ERK1/2 pathways were measured in primary fibroblast cell lines from the proband.

RESULTS

In this case the phenotypic effects that result in a human with both FXS and TSC are shown to be severe. Changes in mTORC1 and ERK1/2 signaling proteins and global protein synthesis were not found to be noticeably different between four cohorts (typically developing, FMR1 full mutation, FMR1 full mutation and TSC1 loss of function mutation, and TSC1 loss of function mutation); however cohort sizes prevented stringent comparisons.

CONCLUSION

It has previously been suggested that disruption of the mTORC1 pathway was reciprocal in TSC and FXS double knock-out mouse models so that the regulation of these pathways were more similar to wild-type mice compared to mice harboring a Fmr1-/y or Tsc2-/+ mutation alone. However, in this first reported case of a human with a diagnosis of both FXS and TSC, substantial clinical impairments, as a result of these two disorders were observed. Differences in the mTORC and ERK1/2 pathways were not clearly established when compared between individuals with either disorder, or both.

Parents' Constructions of the ‘Problem’ during Assessment and Diagnosis of their Child for an Autistic Spectrum Disorder

The majority of studies on the effects of a diagnosis of learning disability in the family have employed traditional ‘loss’ and ‘stress reaction’ paradigms. In contrast to this approach, the current analysis employed a form of discourse analysis to explore the ways in which parents represented the ‘problem’ during the process of assessment of their child for an autistic spectrum disorder. The analysis suggested that parents employed three main discourses in their talk about the ‘problem’, which were termed the discourse of normal development, the medical discourse and the discourse of disability. The ways in which these discourses were used in constructing the ‘problem’, their relationship to each other and the discursive work underlying the diagnosis are discussed. Although this study focused on the specific case of autism, it is suggested that the findings could inform thinking around the complex ways in which medical diagnosis is constructed by families and extend our understanding of this important aspect of health care practice.

A Psychosocial Study on Restricted Interests in High Functioning Persons with Pervasive Developmental Disorders

To explore how restricted interests are perceived by individuals with pervasive developmental disorders (PDDs) and their relatives, 18 in-depth semi-structured interviews were conducted with six high-functioning individuals with PDD, their parents and/or siblings. Results revealed that restricted interests play a significant role in the person’s life that is acknowledged by most of their relatives. They provide a sense of well-being, a positive way of occupying one’s time, a source of personal validation, and an incentive for personal growth. However, these positive dimensions are counterbalanced by their negative consequences. Following the demands and the support from their environment, the participants in the study reported to have involved themselves in an active process to adapt, reduce or diversify their restricted interests. These findings on transformation of restricted interests under development and social pressure may have theoretical (for cognitive models of autism) and clinical consequences (in their use for rehabilitation).

Is There Really a Link Between Engineering and Autism?

Baron-Cohen, Wheelwright, Scott, Bolton and Goodyear (1997) found that engineering was over-represented as an occupation among fathers of individuals with autism, in comparison to fathers of non-autistic individuals. We present further analyses of their data which suggest that while engineering is indeed more common than would be expected, so too are the occupations of medicine, science, and accounting. In addition, skilled and unskilled manual workers are less common as fathers than would be predicted. Moreover, our analyses indicate that accountancy and science may be as strongly associated with fathers of individuals with autism as is engineering. These results could be seen as being consistent with a link between parental occupation and incidence of autism. However, we also consider whether they might arise from a sampling bias, with generally 'less-professional' occupations being under-represented among Baron-Cohen and colleagues' sample.

Fragile X Syndrome, Autism and Autistic Features

The relationship between fragile X syndrome and autism is reviewed. Results from a semi-structured questionnaire survey of development and behaviour in boys with fragile X syndrome, Down's syndrome and learning disability of unknown aetiology are presented. A behavioural profile characteristic of many boys with fragile X syndrome was identified which distinguished them from both other groups. Fragile X boys did not show more autism than boys with idiopathic learning disability but they did have a common autistic-like profile of communicatory and stereotypic disturbances, most notably delayed echolalia, repetitive speech and hand flapping. Boys with idiopathic learning disability showed difficulties more in areas of social functioning. Boys with Down's syndrome were characterized by fewer difficulties in social functioning and ritualistic/stereotypic tendencies but this might have been explained by subject ascertainment bias. Behavioural items distinguishing boys with fragile X significantly from both other groups retained their significance even when individuals with autism were excluded from statistical analysis. The findings provide further support for the notion of a behavioural phenotype in boys with fragile X syndrome.

Making Sense in a Fragmentary World

The communicative capabilities of people with autism are impaired and limited in significant ways. The problems are characterized by a lack of intentionality and symbol formation, which indicates that the deviant development of communication in autism is associated with a specific cognitive style. The central coherence theory can offer insight into the specific communication problems of people with autism, since a weaker drive for central coherence leads to problems in sense-making and, consequently, in communication. In the case of the comorbidity of autism and learning disability, the communication problems are aggravated. The crucial point is the determination of the level of sense-making, taking this comorbidity into account. Assessment and intervention have to be tuned to individual needs, in order to increase the communicative competence of people with autism and learning disability.