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Adams KL, Mandy W, Catmur C, Bird G. Potential mechanisms underlying the association between feeding and eating disorders and autism. Neurosci Biobehav Rev 2024; 162:105717. [PMID: 38754718 DOI: 10.1016/j.neubiorev.2024.105717] [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: 02/05/2024] [Revised: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/18/2024]
Abstract
There is a reliable association between autism and Feeding and Eating Disorders. Concerningly, where these two conditions co-occur, clinical outcomes of Feeding and Eating Disorders are significantly worse, and treatment less effective, than when the Feeding and Eating Disorders occur in neurotypical individuals. Problematically, the reason for the association between autism and Feeding and Eating Disorders is poorly understood, which constrains advances in clinical care. This paper outlines several possible mechanisms that may underlie the observed association and suggests ways in which they may be empirically tested. Mechanisms are split into those producing an artefactual association, and those reflecting a genuine link between conditions. Artefactual associations may be due to conceptual overlap in both diagnostic criteria and measurement, Feeding and Eating Disorders causing transient autistic traits, or the association being non-specific in nature. A genuine association between autism and Feeding and Eating Disorders may be due to common causal factors, autism directly or indirectly causing Feeding and Eating Disorders, and Feeding and Eating Disorders being a female manifestation of autism.
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Affiliation(s)
- Kiera Louise Adams
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
| | - William Mandy
- Division of Psychology and Language, University College London, London, UK
| | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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2
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Saure E, Laasonen M, Kylliäinen A, Hämäläinen S, Lepistö-Paisley T, Raevuori A. Social communication and restricted, repetitive behavior as assessed with a diagnostic tool for autism (ADOS-2) in women with anorexia nervosa. J Clin Psychol 2024. [PMID: 38712729 DOI: 10.1002/jclp.23700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 02/01/2024] [Accepted: 04/24/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE In anorexia nervosa (AN), the traits of autism spectrum disorder (ASD) are associated with poor outcomes. However, the subtle nature of these characteristics remains poorly understood. We investigated the in-depth patterns of ASD traits using Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) in women with AN. METHODS Of 28 women with ICD-10 AN, 16 (age 19-30 years) participated in the ADOS-2, a video-recorded, semistructured diagnostic assessment for social communication and interaction and restricted, repetitive behaviors and interests related to ASD. None of the participants had previously been diagnosed with ASD. Other measurements included the Eating Disorder Examination Questionnaire and the Wechsler Abbreviated Scale of Intelligence-IV. RESULTS Five individuals (18% of all, 31% of those assessed) scored above the cutoff for autism in ADOS-2. They had challenges in social communication and interaction, manifesting as sustained difficulties in social relationships and deficits in conversation skills. Few described being frequently misunderstood by others, including in the eating disorder treatment settings. Three individuals showed prominent restricted and repetitive behaviors such as ritual seeking, eating-related routines, sensory sensitivity related to food texture and selective eating, and intense interest in specific topics. The mean duration of AN in women above the cutoff was twice as long compared with those below (12.3 vs. 6.2 years). DISCUSSION The ASD-related characteristics and behavior appear to contribute to the manifestation and duration of AN in a subgroup of women. Among these women, the traits of ASD appear to be mixed with eating disorder symptoms, which should be taken into account in the treatment.
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Affiliation(s)
- Emma Saure
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Marja Laasonen
- Logopedics, School of Humanities, Philosophical Faculty, University of Eastern Finland, Joensuu, Finland
| | - Anneli Kylliäinen
- Psychology, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Sini Hämäläinen
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Tuulia Lepistö-Paisley
- Department of Child Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Department of Psychiatry, Division of Adolescent Psychiatry, Helsinki University Hospital, Helsinki, Finland
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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3
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Wu R, Leow K, Yu N, Rafter C, Rosenbaum K, F de C Hamilton A, White SJ. Evaluative contexts facilitate implicit mentalizing: relation to the broader autism phenotype and mental health. Sci Rep 2024; 14:4697. [PMID: 38409351 PMCID: PMC10897468 DOI: 10.1038/s41598-024-55075-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
One promising account for autism is implicit mentalizing difficulties. However, this account and even the existence of implicit mentalizing have been challenged because the replication results are mixed. Those unsuccessful replications may be due to the task contexts not being sufficiently evaluative. Therefore, the current study developed a more evaluative paradigm by implementing a prompt question. This was assessed in 60 non-autistic adults and compared with a non-prompt version. Additionally, parents of autistic children are thought to show a genetic liability to autistic traits and cognition and often report mental health problems, but the broader autism phenotype (BAP) is an under-researched area. Thus, we also aimed to compare 33 BAP and 26 non-BAP mothers on mentalizing abilities, autistic traits, compensation and mental health. Our results revealed that more evaluative contexts can facilitate implicit mentalizing in BAP and non-BAP populations, and thus improve task reliability and replicability. Surprisingly, BAP mothers showed better implicit mentalizing but worse mental health than non-BAP mothers, which indicates the heterogeneity in the broader autism phenotype and the need to promote BAP mothers' psychological resilience. The findings underscore the importance of contexts for implicit mentalizing and the need to profile mentalizing and mental health in BAP parents.
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Affiliation(s)
- Ruihan Wu
- Institute of Cognitive Neuroscience, University College London, Alexandra House, 17 Queen Square, London, WC1N 3AZ, UK.
| | - Karen Leow
- National Institute of Education, Nanyang Technological University, Singapore, Singapore
| | - Nicole Yu
- National University of Singapore, Singapore, Singapore
| | - Ciara Rafter
- Department for Environment, Food, and Rural Affairs, Manchester, UK
| | - Katia Rosenbaum
- Institute of Cognitive Neuroscience, University College London, Alexandra House, 17 Queen Square, London, WC1N 3AZ, UK
| | - Antonia F de C Hamilton
- Institute of Cognitive Neuroscience, University College London, Alexandra House, 17 Queen Square, London, WC1N 3AZ, UK
| | - Sarah J White
- Institute of Cognitive Neuroscience, University College London, Alexandra House, 17 Queen Square, London, WC1N 3AZ, UK.
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4
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Schröder SS, Danner UN, Spek AA, van Elburg AA. Exploring the intersection of autism spectrum disorder and eating disorders: understanding the unique challenges and treatment considerations for autistic women with eating disorders. Curr Opin Psychiatry 2023; 36:419-426. [PMID: 37781983 DOI: 10.1097/yco.0000000000000894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
PURPOSE OF REVIEW Autistic women struggle with high levels of both autistic eating behaviours and disordered eating behaviours , which might make them particularly vulnerable to develop eating disorders. Research investigating the presence and characteristics of eating disorders in autistic women is however limited, as is research examining the role of autism in the treatment and recovery of an eating disorder in autistic women. RECENT FINDINGS The link between autism and eating disorders has mainly been investigated from the field of eating disorder research, with studies finding an overrepresentation of autism or autistic traits in eating disorders populations. Findings also suggest that autism or autistic traits are associated with a more serious presentation of the eating disorders, including a higher chance of a chronic course of the eating disorders. Most studies however lack comprehensive autism assessments, making it difficult to determine the actual prevalence of autism and its role in women with eating disorders. SUMMARY Autistic women with an eating disorder seem to suffer from more complex eating disorders and seem to not benefit from current treatment modalities. This could be partly related to specific autism characteristics such as sensory sensitivities, which are not being considered by current treatment protocols. Future research needs to shed light on what underlies the eating behaviours of autistic women with an eating disorder, in order to help to adapt current treatment modalities to meet the unique needs of these women.
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Affiliation(s)
- Sabrina S Schröder
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
| | - Annelies A Spek
- Autism Expert Center, Goyergracht Zuid 39, Eemnes, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Zeist
- Department of Clinical Psychology, Utrecht University, Utrecht
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5
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Fithall K, Gray IE, Linardon J, Phillipou A, Donaldson PH, Albein-Urios N, Enticott PG, Fuller-Tyszkiewicz M, Kirkovski M. Exploring the role of autistic traits and eating disorder psychopathology on mentalising ability in the general population. BMC Psychol 2023; 11:269. [PMID: 37674242 PMCID: PMC10483798 DOI: 10.1186/s40359-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/04/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study evaluated the role of overlapping traits and characteristics related to autism spectrum disorder (autism) and anorexia nervosa (AN) in the general population, and the impact of these traits on mentalising ability. METHODS A sample of young adults (N = 306), aged 18-25 years, was recruited to complete an online study that consisted of 4 measures: the Autism-Spectrum Quotient, Eating Disorder Examination Questionnaire, the Mentalization Scale, and the Reading the Mind in the Eyes task. RESULTS Higher levels of autistic traits, particularly difficulty with attention switching, were associated with increased eating disorder psychopathology. Overall, autistic traits and eating disorder psychopathology were related among females, but not males. Difficulty with attention switching, however, was related to eating disorder psychopathology among both females and males. Autistic traits also appear to have a greater role in mentalising ability than does eating disorder psychopathology. CONCLUSION The role of attention switching in overlapping traits of autism and eating disorder psychopathology needs to be more comprehensively evaluated by future research, as does the role of biological sex. Expanded knowledge in this field will help to better understand and evaluate symptoms at presentation, leading to clearer diagnoses and potentially better treatment outcomes.
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Affiliation(s)
- Kate Fithall
- School of Psychology, Deakin University, Geelong, Australia
| | - Indigo E Gray
- School of Psychology, Deakin University, Geelong, Australia
| | - Jake Linardon
- School of Psychology, Deakin University, Geelong, Australia
| | - Andrea Phillipou
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
- Orygen, Melbourne, VIC, Australia
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, VIC, Australia
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
- Department of Mental Health, Austin Hospital, Melbourne, VIC, Australia
| | | | | | | | | | - Melissa Kirkovski
- School of Psychology, Deakin University, Geelong, Australia.
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
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Finding the Proportion of Females with Autistic Spectrum Disorder Who Develop Anorexia Nervosa, the True Prevalence of Female ASD and Its Clinical Significance. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020272. [PMID: 36832401 PMCID: PMC9955974 DOI: 10.3390/children10020272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/04/2023]
Abstract
It appears that up to 80% of females with autistic spectrum disorder (ASD) have not been diagnosed by the age of 18. This translates to a prevalence of about 5-6%, and if true, has serious implications for female mental health. One way of finding the true value is to use Bayes' Theorem with a comorbid condition as a more easily recognizable flag. An obvious choice is anorexia nervosa (AN), but it transpires that the proportion of women with ASD who develop AN is unknown. This study uses published data in novel ways to provide two methods of estimating a range for this variable, and gives a median value of 8.3% for AN in ASD and, with four other methods, a median prevalence of 6% for female ASD. The clinical implications of the diagnosis and management of ASD and its comorbidities are discussed and, as an example, a solution is provided for the rate of ASD in symptomatic generalized joint hypermobility. It is probable that one in six women with a mental health condition is autistic.
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Turnbull G, Lego S, Kennedy BL, Alexi J, Li YR, Engel MM, Mann G, Bayliss DM, Farrell S, Bell J. Sizing up the crowd: Assessing spatial integration difficulties in body size judgements across eating disorder symptomatology. Front Psychol 2023; 13:1003250. [PMID: 36687820 PMCID: PMC9853910 DOI: 10.3389/fpsyg.2022.1003250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/30/2022] [Indexed: 01/07/2023] Open
Abstract
Introduction Body size judgements are frequently biased, or inaccurate, and these errors are further exaggerated for individuals with eating disorders. Within the eating disorder literature, it has been suggested that exaggerated errors in body size judgements are due to difficulties with integration. Across two experiments, we developed a novel integration task, named the Ebbinghaus Illusion for Bodies in Virtual Reality (VR), to assess whether nearby bodies influence the perceived size of a single body. VR was used to simulate the appearance of a small crowd around a central target body. Method and Results In Experiment 1 (N = 412), participants were required to judge the size of a central female target within a crowd. Experiment 1 revealed an Ebbinghaus Illusion, in which a central female appeared larger when surrounded by small distractors, but comparatively smaller when surrounded by large distractors. In other words, the findings of Experiment 1 demonstrate that surrounding crowd information is integrated when judging an individual's body size; a novel measure of spatial integration (i.e., an Ebbinghaus Illusion for Bodies in VR). In Experiment 2 (N = 96), female participants were selected based on high (n = 43) and low (n = 53) eating disorder symptomatology. We examined whether the magnitude of this illusion would differ amongst those with elevated versus low eating disorder symptomatology, in accordance with weak central coherence theory, with the high symptomatology group displaying less spatial integration relative to the low group. The results of Experiment 2 similarly found an Ebbinghaus Illusion for Bodies in VR. However, illusion magnitude did not vary across high and low symptomatology groups. Discussion Overall, these findings demonstrate that surrounding crowd information is integrated when judging individual body size; however, those with elevated eating disorder symptomatology did not show any integration deficit on this broader measure of spatial integration.
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Affiliation(s)
- Georgia Turnbull
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia,*Correspondence: Georgia Turnbull,
| | - Sophia Lego
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Briana L. Kennedy
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Joanna Alexi
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Yanqi R. Li
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Manja M. Engel
- Faculty of Social and Behavioural Sciences, Experimental Psychology, Helmholtz Institute, Utrecht University, Utrecht, Netherlands
| | - Georgina Mann
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Donna M. Bayliss
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Simon Farrell
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
| | - Jason Bell
- School of Psychological Science, University of Western Australia, Crawley, WA, Australia
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Preterm birth and weight-for-gestational age for risks of autism spectrum disorder and intellectual disability: A nationwide population-based cohort study. J Formos Med Assoc 2022; 122:493-504. [DOI: 10.1016/j.jfma.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/11/2022] [Accepted: 10/13/2022] [Indexed: 11/11/2022]
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Galvin J, Evans EH, Talbot CV, Wilson C, Richards G. The associations between autistic traits and disordered eating/drive for muscularity are independent of anxiety and depression in females but not males. PLoS One 2022; 17:e0276249. [PMID: 36251679 PMCID: PMC9576073 DOI: 10.1371/journal.pone.0276249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 10/03/2022] [Indexed: 11/19/2022] Open
Abstract
Previous research has shown a positive correlation between autistic traits and eating disorder symptoms, and this relationship appears to be independent of co-occurring mental health status. The current study followed a pre-registered analysis plan with the aim to investigate a previously unconsidered factor in the relationship between autistic traits and disorders of eating and body image: the drive for muscularity. Participants (N = 1068) completed the Autism Spectrum Quotient (AQ), Hospital Anxiety and Depression Scale (HADS), Eating Attitudes Test-26 (EAT-26) and Drive for Muscularity Scale (DMS). Positive correlations between AQ and EAT-26 and AQ and DMS were observed. In females, AQ remained significantly correlated with EAT-26 and DMS when controlling for co-occurring anxiety and depression symptoms, but this was not the case in males. These findings demonstrate the moderating role of sex, and the need to consider autistic traits in individuals diagnosed with, or at a heightened risk for, disorders of eating and body image.
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Affiliation(s)
- John Galvin
- Department of Psychology, Birmingham City University, Birmingham, United Kingdom
| | | | | | - Claire Wilson
- School of Education, University of Strathclyde, Glasgow, United Kingdom
| | - Gareth Richards
- Faculty of Medical Sciences, School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
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Abstract
In the last decades, increasing attention has been provided to socio-cultural and neurobiological factors involved in the psychopathology of feeding and eating disorders (FED), encouraging a multifactorial approach. In this framework, several authors stressed an association between FED and other kinds of psychiatric disorders from both a psychopathological and a neurobiological point of view. In particular, many promising contributions are focusing on the possible link between FED and autism spectrum disorder (ASD). Growing interest about this association rose from the frequently reported evidence of ASD-like traits amongst FED patients and abnormal eating behaviors amongst patients with ASD. This narrative review overview aims to summarize the most relevant findings about the overlap between different kinds of FED and the autism spectrum, taking into account the most recent hypotheses about the psychopathology of both these conditions. While most of the studies focused on anorexia nervosa, both ASD and autistic traits seem to be detectable also in other kinds of FED. In addition, the recently increased interest toward a dimensional approach to psychopathology led to progressively broadening the concept of ASD, focusing on its subthreshold and gender-specific manifestations and on its link with other psychiatric conditions, including FED. Globally the studies summarized here provide further support to theoretical models featuring a neurodevelopmental approach for mental disorders. In particular, FED have been conceptualized as a possible psychopathological trajectory of a neurodevelopmental alteration, toward which female gender would act as one of many predisposing factors.
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Adams KL, Murphy J, Catmur C, Bird G. The role of interoception in the overlap between eating disorders and autism: Methodological considerations. EUROPEAN EATING DISORDERS REVIEW 2022; 30:501-509. [PMID: 35411642 PMCID: PMC9543236 DOI: 10.1002/erv.2905] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/24/2022] [Accepted: 03/31/2022] [Indexed: 01/10/2023]
Abstract
Significant comorbidity has been demonstrated between feeding and eating disorders and autism. Atypical interoception (perception of bodily signals) may, at least in part, be responsible for this association, as it has been implicated in the aetiology of both conditions. However, significant methodological limitations are impeding progress in this area. This paper provides a brief overview of how interoception has been linked to autism and feeding and eating disorders in both adolescent and adult populations before identifying several issues with current measures of interoception. We suggest that methodological issues may be contributing to the inconsistency in the empirical literature, and provide suggestions for future research. Atypical interoception is linked to both feeding and eating disorders, and autism and may contribute to the comorbidity between the two. Existing measures of interoception across cardiac, gastric and respiratory domains are severely limited. Novel and better‐validated measures of interoception will allow us to better understand the clinical potential of interoceptive training.
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Affiliation(s)
| | | | - Caroline Catmur
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Geoffrey Bird
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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12
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Carter Leno V, Micali N, Bryant-Waugh R, Herle M. Associations between childhood autistic traits and adolescent eating disorder behaviours are partially mediated by fussy eating. EUROPEAN EATING DISORDERS REVIEW 2022; 30:604-615. [PMID: 35388530 PMCID: PMC9542277 DOI: 10.1002/erv.2902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 12/12/2022]
Abstract
Objective Previous literature shows an increased risk for eating disorders in autistic individuals. This study tested whether fussy eating contributes to the association between childhood autistic traits and adolescent eating disorder behaviours. Method Using data from the Avon Longitudinal Study of Parents and Children, we estimated the intercept and slope of parent‐rated autistic traits and fussy eating between 7 and 14 years (N = 8982) and their association with self‐reported eating disorder behaviours at age 14 years, including the indirect path from autistic traits to eating disorder behaviours via fussy eating. Analyses were adjusted for child sex, maternal age at delivery, maternal body mass index and maternal education. Results Analyses found a small indirect pathway from autistic traits intercept to eating disorder behaviours via fussy eating slope (b = 0.017, 95% CI = 0.002–0.032, p = 0.026), with higher levels of autistic traits at age 7 years being associated with a shallower decline in fussy eating, which in turn was associated with greater eating disorder behaviours. Conclusion Findings point towards fussy eating as a potential link between childhood autistic traits and later disordered eating. Addressing fussy eating patterns before they become entrenched may decrease risk for eating disorders later in development. There is evidence that high levels of autistic traits are associated with an increased likelihood of experiencing an eating disorder. The current study sought to test whether the link between autism and eating disorders could in part be explained by variation in fussy eating. In a large prospective cohort study, we found a significant indirect effect of fussy eating, such that higher childhood autistic traits were associated with a shallower decline in fussy eating between childhood and adolescence, which in turn was associated with higher levels of eating disorder behaviours in adolescence.
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Affiliation(s)
- Virginia Carter Leno
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Nadia Micali
- Department of Pediatrics, Gynaecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rachel Bryant-Waugh
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Moritz Herle
- Department of Biostatistics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Rujeedawa T, Zaman SH. The Diagnosis and Management of Autism Spectrum Disorder (ASD) in Adult Females in the Presence or Absence of an Intellectual Disability. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1315. [PMID: 35162336 PMCID: PMC8835194 DOI: 10.3390/ijerph19031315] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 01/04/2023]
Abstract
We review the reasons for the greater male predominance in the diagnosis of autism spectrum disorder in the non-intellectual disabled population and compare it to autism diagnosed in intellectually disabled individuals. Accurate and timely diagnosis is important, as it reduces health inequalities. Females often present later for the diagnosis. The differences are in core features, such as in social reciprocal interaction through 'camouflaging' and restricted repetitive behaviours, that are less noticeable in females and are potentially explained by the biological differences (female protective effect theory) and/or differences in presentation between the two sexes (female autism phenotype theory). Females more often present with internalising co-occurring conditions than males. We review these theories, highlighting the key differences and the impact of a diagnosis on females. We review methods to potentially improve diagnosis in females along with current and future management strategies.
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Affiliation(s)
| | - Shahid H. Zaman
- Cambridge Intellectual & Developmental Disabilities Research Group, Department of Psychiatry, University of Cambridge, Cambridge CB2 8AH, UK;
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14
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Leppanen J, Sedgewick F, Halls D, Tchanturia K. Autism and anorexia nervosa: Longitudinal prediction of eating disorder outcomes. Front Psychiatry 2022; 13:985867. [PMID: 36213911 PMCID: PMC9533087 DOI: 10.3389/fpsyt.2022.985867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 09/05/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Recently, elevated levels of autistic features and autism diagnoses have been reported among people with anorexia nervosa (AN). In clinical settings high levels of autistic features have been linked to more complex, highly comorbid illness presentation and poorer treatment outcome. This study aimed to examine whether autistic features predict AN symptom profile in long term. METHODS Altogether 118 women with lived experience of AN completed two autism assessments at time 1, the Autism Diagnostic Observation Schedule (ADOS) and the short version of the Autism Quotient (AQ10). Measures assessing AN symptom profile, including eating disorders symptoms, anxiety, depression, OCD symptoms, and Body Mass Index (BMI), were also recorded. The symptom profile measures were administered again 6 months and 2 years later. We conducted two analyses to examine the extent to which the ADOS and AQ10 scores predicted broad AN symptom profile at each three time points. RESULTS Overall, high levels of autistic features were consistently associated with worse psychological symptoms, but not BMI, across all time points. Both the analysis using baseline ADOS scores and self-reported AQ10 scores showed similar pattern. CONCLUSION The present findings consolidate previously reported associations between autistic features and worse psychological outcome among people with AN. The findings also suggest that self-report measures may be sufficient for assessing the impact of autistic features on illness outcome among people with AN. Importantly, the study highlights the need for development and further investigation of neurodiversity accommodations in the treatment of AN.
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Affiliation(s)
- Jenni Leppanen
- Department of Neuroimaging, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | | | - Daniel Halls
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Foundation Trust National Eating Disorder Service, London, United Kingdom.,Department of Psychology, Illia State University, Tbilisi, Georgia.,Psychological Set Research and Correction Center, Tbilisi State Medical University, Tbilisi, Georgia
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15
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Schaumberg K, Zerwas SC, Bulik CM, Fiorentini C, Micali N. Prospective associations between childhood social communication processes and adolescent eating disorder symptoms in an epidemiological sample. Eur Child Adolesc Psychiatry 2021; 30:1929-1938. [PMID: 33064208 PMCID: PMC8050127 DOI: 10.1007/s00787-020-01655-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 09/25/2020] [Indexed: 02/03/2023]
Abstract
Deficits in social cognition and communication, the processes associated with human social behavior and interaction, have been described in individuals with eating disorder psychopathology. The current study examined whether social communication characteristics present in middle childhood (ages 8-14) were associated with eating disorder behaviors, cognitions, and diagnoses across adolescence (ages 14-18) in a large, population-based sample. Participants (N = 4864) were children enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC), a population-based, prospective study of women and their children. Regression methods tested prospective associations between social functioning using a facial emotion recognition task and parentally reported social communication symptoms (or difficulties), measured by the Social Communication Disorder Checklist (SCDC), with eating disorder symptoms and diagnoses. Misattribution of faces as sad or angry at age 8.5 was associated with purging and anorexia nervosa diagnosis at age 14, respectively, among girls. Furthermore, autistic-like social communication difficulties during middle childhood were associated with bulimia nervosa symptoms during adolescence among both girls and boys. Results did not support global associations between measured social communication deficits and eating disorder risk in this sample, but specific difficulties with facial emotion recognition and social communication may enhance the risk for disordered eating behaviors.
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Affiliation(s)
- Katherine Schaumberg
- Department of Psychiatry, University of Wisconsin, 6001 Research Park Blvd, Madison, WI, 53719, USA.
| | - Stephanie C. Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, United States,Department of Nutrition, University of North Carolina at Chapel Hill, United States,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Chiara Fiorentini
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland
| | - Nadia Micali
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Switzerland,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, United States,Institute of Child Health, University College London, United Kingdom
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16
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Abstract
Over the past four decades there have been significant advances in our understanding of autism, yet services for autistic adults continue to lag far behind those for children, and prospects for employment and independent living remain poor. Adult outcomes also vary widely and while cognitive and language abilities are important prognostic indicators, the influence of social, emotional, familial and many other factors remains uncertain. For this special issue marking the 40th anniversary of DSM-III, the present paper describes the changing perspectives of autism in adulthood that have occurred over this period, explores individual and wider environmental factors related to outcome, and suggests ways in which services need to be changed to improve the future for adults living with autism.
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Affiliation(s)
- Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK.
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17
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Stewart GR, Corbett A, Ballard C, Creese B, Aarsland D, Hampshire A, Charlton RA, Happé F. The Mental and Physical Health Profiles of Older Adults Who Endorse Elevated Autistic Traits. J Gerontol B Psychol Sci Soc Sci 2021; 76:1726-1737. [PMID: 32756953 DOI: 10.1093/geronb/gbaa112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The mental and physical health profile of autistic people has been studied in adolescence and adulthood, with elevated rates of most conditions being reported. However, this has been little studied taking a dimensional approach to autistic traits and in older age. METHODS A total of 20,220 adults aged 50-81 years from the PROTECT study reported whether they experienced persistent sociocommunicative traits characteristic of autism. Approximately 1%, 276 individuals, were identified as endorsing elevated autistic traits in childhood and currently, henceforth the "Autism Spectrum Trait" (AST) group. An age- and gender-matched comparison group was formed of 10,495 individuals who did not endorse any autistic behavioral traits, henceforth the "Control Older Adults" (COA) group. Differences between AST and COA groups were explored in self-reported psychiatric diagnoses, self-reported symptoms of current depression and anxiety, and self-reported physical health diagnoses. Associations were also examined between autistic traits and health across the whole sample. RESULTS The AST group reported significantly elevated rates of psychiatric diagnoses compared to the COA group. Additionally, the AST group showed significantly higher self-reported symptoms of current depression and anxiety than the COA group. However, few differences were observed in individual physical health conditions, and no differences in total co-occurring physical diagnoses between groups. Similar associations between autistic traits and health were also found taking a dimensional approach across the whole sample. DISCUSSION These findings suggest that older adults with elevated autistic traits may be at greater risk of poorer mental, but not physical, health in later life. Future studies should incorporate polygenic scores to elucidate the possible genetic links between the propensity to autism/high autistic traits and to psychiatric conditions, and to explore whether those with elevated autistic traits experience particular barriers to mental health care.
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Affiliation(s)
- Gavin R Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, UK
| | - Clive Ballard
- College of Medicine and Health, University of Exeter, UK
| | - Byron Creese
- College of Medicine and Health, University of Exeter, UK
| | - Dag Aarsland
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | | | - Francesca Happé
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
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18
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Kerr-Gaffney J, Mason L, Jones E, Hayward H, Harrison A, Murphy D, Tchanturia K. Autistic Traits Mediate Reductions in Social Attention in Adults with Anorexia Nervosa. J Autism Dev Disord 2021; 51:2077-2090. [PMID: 32910314 PMCID: PMC8124046 DOI: 10.1007/s10803-020-04686-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is associated with difficulties in social and emotional functioning. A significant proportion of individuals with AN show autistic traits, which may influence social attention. This study examined attention to faces and facial features in AN, recovered AN (REC), and healthy controls, as well as relationships with comorbid psychopathology. One hundred and forty-eight participants’ eye movements were tracked while watching a naturalistic social scene. Anxiety, depression, alexithymia, and autistic traits were assessed via self-report questionnaires. Participants with AN spent significantly less time looking at faces compared to REC and controls; patterns of attention to individual facial features did not differ across groups. Autistic traits mediated the relationship between group and time spent looking at faces.
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Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK.
| | - Luke Mason
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Emily Jones
- Centre for Brain & Cognitive Development, Birkbeck, University of London, London, UK
| | - Hannah Hayward
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
| | - Declan Murphy
- Department of Forensic & Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, London, SE5 8AZ, UK
- Psychological Medicine Clinical Academic Group, National Eating Disorders Service, South London and Maudsley NHS Trust, London, UK
- Department of Psychology, Ilia State University, Tbilisi, GA, USA
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19
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Pruccoli J, Solari A, Terenzi L, Malaspina E, Angotti M, Pignataro V, Gualandi P, Sacrato L, Cordelli DM, Franzoni E, Parmeggiani A. Autism spectrum disorder and anorexia nervosa: an Italian prospective study. Ital J Pediatr 2021; 47:59. [PMID: 33750445 PMCID: PMC7945370 DOI: 10.1186/s13052-021-01006-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Potential overlaps exist between psychopathological features of Anorexia Nervosa (AN) and Autism Spectrum Disorder (ASD). The impact of malnutrition on autistic traits in patients with AN should be considered. This study investigates possible associations among the psychopathology of Eating Disorders (EDs), ASD traits and BMI in a group of young patients with AN, using the EDI-3 (Eating Disorder Inventory-3) test and gold-standard measures for ASD. METHODS Prospective study involving 23 inpatients admitted to an Italian Centre for paediatric ED. ASD traits and ED psychopathology were assessed administering the ADOS-2 (Autism Diagnostic Observation Schedule-2), AQ (Autism Quotient) and EDI-3 tests. Both present and past autistic traits were investigated using different versions of AQ. Correlations were adjusted for BMI, Obsessive Compulsive Disorder (OCD) comorbidity and concurrent antipsychotic treatments. RESULTS An ASD diagnosis was possible in 22% of patients. Significant correlations were documented between ASD traits and ED psychopathology: AQ total-Interpersonal problems (IPC) (p = 0.041); AQ total-Global psychological maladjustment (GMPC) (p = 0.027); AQ social skills-Ineffectiveness (IC) (p = 0.018); AQ social skills-IPC (p = 0.019); AQ social skills-Affective problems (APC) (p = 0.025); AQ social skills-GMPC (p = 0.007); AQ attention switching-IPC (p = 0.020); ADOS-2 imagination-IC (p = 0.035). These correlations were independent of BMI, OCD and antipsychotic treatments. CONCLUSIONS ASD traits presented high prevalence in a group of young inpatients with AN. These traits were significantly correlated to 4 specific EDI-3 subscales and independent of BMI. This is the first study to investigate the relationship between ASD traits as measured with gold-standard measures, EDI-3 scores, and BMI.
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Affiliation(s)
- Jacopo Pruccoli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Altea Solari
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Letizia Terenzi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elisabetta Malaspina
- Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Marida Angotti
- Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Veronica Pignataro
- Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Paola Gualandi
- Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Leonardo Sacrato
- Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Duccio Maria Cordelli
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Emilio Franzoni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.,Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Antonia Parmeggiani
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy. .,Regional Centre for Feeding Eating Disorders, Child Neurology and Psychiatry Unit, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy.
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20
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Dinkler L, Taylor MJ, Råstam M, Hadjikhani N, Bulik CM, Lichtenstein P, Gillberg C, Lundström S. Anorexia nervosa and autism: a prospective twin cohort study. J Child Psychol Psychiatry 2021; 62:316-326. [PMID: 32496594 DOI: 10.1111/jcpp.13265] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. METHODS In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). RESULTS We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. CONCLUSIONS Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.
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Affiliation(s)
- Lisa Dinkler
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mark J Taylor
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Nouchine Hadjikhani
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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21
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Timko CA, Herrington JD, Bhattacharya A, Kuschner ES, Yerys BE. Caregiver Report of Executive Functioning in Adolescent Females With Anorexia Nervosa or Autism Spectrum Disorder. Front Psychol 2021; 11:586264. [PMID: 33633624 PMCID: PMC7899966 DOI: 10.3389/fpsyg.2020.586264] [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] [Received: 07/22/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
Current literature suggesting a shared endophenotype between individuals with anorexia nervosa (AN) and autism spectrum disorder (ASD) related to executive functioning (EF) has several limitations: performance-based instead of ecologically valid measures of set-shifting are used, lack of comparisons between same-sex groups, and reliance on adult samples only. This was the first study directly comparing female youth with ASD to female youth with AN using an ecologically valid measure of EF. A secondary data analysis combined caregiver-reported EF on the Behavior Rating Inventory of Executive Functioning (BRIEF) for 22 female adolescent youth with AN and 29 female adolescent youth with ASD. EF in each group was compared to population norms, and EF was compared between groups. Compared to population norms, adolescents with AN had elevated scores on shift, initiate, and emotional control scales, and adolescents with ASD had elevated scores on all scales of the BRIEF and were more likely to have scores in the clinical range. There were significant differences between groups on all but three scales. The cognitive profiles and clinical scores of AN females were not comparable to those of ASD females. The findings reveal a clear clinical impairment in females with ASD but not in females with AN. The results do not support the hypothesis of similar real-world EF profiles between these groups. The results encourage further exploration into the similarities and distinctions between these two disorders.
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Affiliation(s)
- C Alix Timko
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - John D Herrington
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - Anushua Bhattacharya
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Emily S Kuschner
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
| | - Benjamin E Yerys
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphian, Pennsylvania
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22
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Hull L, Levy L, Lai MC, Petrides KV, Baron-Cohen S, Allison C, Smith P, Mandy W. Is social camouflaging associated with anxiety and depression in autistic adults? Mol Autism 2021; 12:13. [PMID: 33593423 PMCID: PMC7885456 DOI: 10.1186/s13229-021-00421-1] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/03/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is inconsistent evidence for a clear pattern of association between 'camouflaging' (strategies used to mask and/or compensate for autism characteristics during social interactions) and mental health. METHODS This study explored the relationship between self-reported camouflaging and generalised anxiety, depression, and social anxiety in a large sample of autistic adults and, for the first time, explored the moderating effect of gender, in an online survey. RESULTS Overall, camouflaging was associated with greater symptoms of generalised anxiety, depression, and social anxiety, although only to a small extent beyond the contribution of autistic traits and age. Camouflaging more strongly predicted generalised and social anxiety than depression. No interaction between camouflaging and gender was found. LIMITATIONS These results cannot be generalised to autistic people with intellectual disability, or autistic children and young people. The sample did not include sufficient numbers of non-binary people to run separate analyses; therefore, it is possible that camouflaging impacts mental health differently in this population. CONCLUSIONS The findings suggest that camouflaging is a risk factor for mental health problems in autistic adults without intellectual disability, regardless of gender. We also identified levels of camouflaging at which risk of mental health problems is highest, suggesting clinicians should be particularly aware of mental health problems in those who score at or above these levels.
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Affiliation(s)
- Laura Hull
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Lily Levy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
- Present Address: Homerton University Hospital NHS Foundation Trust, London, UK
| | - Meng-Chuan Lai
- Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Toronto, Canada
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - K. V. Petrides
- London Psychometrics Laboratory, University College London, London, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Will Mandy
- Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB UK
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23
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Solmi F, Bentivegna F, Bould H, Mandy W, Kothari R, Rai D, Skuse D, Lewis G. Trajectories of autistic social traits in childhood and adolescence and disordered eating behaviours at age 14 years: A UK general population cohort study. J Child Psychol Psychiatry 2021; 62:75-85. [PMID: 32361997 PMCID: PMC8425328 DOI: 10.1111/jcpp.13255] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Some people with eating disorders have difficulties with social communication. However, no longitudinal evidence regarding the direction of this association exists. We investigated trajectories of autistic social traits across childhood and adolescence in adolescents with and without disordered eating behaviours in early adolescence. METHODS We used data from the Avon Longitudinal Study of Parents and Children. Our disordered eating measure indicated presence of any, monthly and weekly disordered eating (fasting, purging, dieting, binge eating) at age 14 years. Autistic social traits were reported by mothers using the Social and Communication Disorders Checklist (SCDC) at age seven, 11, 14 and 16 years. We modelled SCDC score trajectories using multilevel negative binomial models adjusting for a number of child- and maternal-level confounders. RESULTS Of the 5,381 adolescents included in our sample, 421 (7.8%) experienced one or more disordered eating behaviours, and 148 (2.8%) weekly episodes. Adolescents with disordered eating had a 20% increase in SCDC scores (relative risk (RR) 1.23, 95% confidence interval (CI):1.14, 1.32) compared to those without disordered eating. This association was particularly apparent for those reporting weekly (RR 1.43, 95%CI: 1.27, 1.61) as opposed to monthly disordered eating (RR 1.12, 95%CI: 1.01, 1.22). CONCLUSIONS Greater autistic social traits in childhood could represent a risk factor for the development of disordered eating in adolescence. Although mechanisms of this association need to be elucidated, clinicians should be aware that autistic social traits could have predated the eating disorder when managing people with these conditions.
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Affiliation(s)
| | | | - Helen Bould
- Centre for Academic Mental HealthPopulation Health ScienceUniversity of BristolBristolUK,Gloucestershire Health and Care NHS Foundation TrustGloucesterUK
| | - William Mandy
- Division of Psychology and Language SciencesUniversity College LondonLondonUK
| | - Radha Kothari
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Dheeraj Rai
- Centre for Academic Mental HealthPopulation Health ScienceUniversity of BristolBristolUK,NIHR Biomedical Research CentreUniversity of BristolBristolUK,Avon and Wiltshire PartnershipNHS Mental Health TrustBristolUK
| | - David Skuse
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | - Glyn Lewis
- Division of PsychiatryUniversity College LondonLondonUK
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24
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Abstract
There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.
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Affiliation(s)
- Claire M Brown
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Mark A Stokes
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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25
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Doyle N. Neurodiversity at work: a biopsychosocial model and the impact on working adults. Br Med Bull 2020; 135:108-125. [PMID: 32996572 PMCID: PMC7732033 DOI: 10.1093/bmb/ldaa021] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION The term neurodiversity is defined and discussed from the perspectives of neuroscience, psychology and campaigners with lived experience, illustrating the development of aetiological theories for included neurodevelopmental disorders. The emerging discourse is discussed with relevance to adults, social inclusion, occupational performance and the legislative obligations of organizations. SOURCES OF DATA Literature is reviewed from medicine, psychiatry, psychology, sociology and popular press. No new data are presented in this article. AREAS OF AGREEMENT There is consensus regarding some neurodevelopmental conditions being classed as neurominorities, with a 'spiky profile' of executive functions difficulties juxtaposed against neurocognitive strengths as a defining characteristic. AREAS OF CONTROVERSY The developing nomenclature is debated and the application of disability status versus naturally occurring difference. Diagnosis and legal protections vary geographically, resulting in heretofore unclear guidance for practitioners and employers. GROWING POINTS The evolutionary critique of the medical model, recognizing and updating clinical approaches considering the emerging consensus and paradigmatic shift. AREAS TIMELY FOR DEVELOPING RESEARCH It is recommended that research addresses more functional, occupational concerns and includes the experiences of stakeholders in research development, moving away from diagnosis and deficit towards multi-disciplinary collaboration within a biopsychosocial model.
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Affiliation(s)
- Nancy Doyle
- Department of Organizational Psychology, Birkbeck University of London, London, UK
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26
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Barrionuevo BA, Chowdhury AR, Lee JM, Dueker ND, Martin ER, Pericak-Vance MA, Cuccaro M. Family History of Eating Disorder and the Broad Autism Phenotype in Autism. Autism Res 2020; 13:1573-1581. [PMID: 32888262 DOI: 10.1002/aur.2378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 11/07/2022]
Abstract
Autism features occur frequently among individuals with eating disorders (ED). This co-occurrence is not well understood but there is speculation that select traits (e.g., rigidity) are common to both autism and ED. To explore the co-occurrence of autistic traits and ED features, we used the Simons Simplex Collection (SSC; N = 2,623 families) to test whether first-degree relatives of individuals with autism with a history of ED features had more autism traits, as measured by the Broad Autism Phenotype Questionnaire (BAP-Q), compared to relatives with no history of ED. The frequency of individuals with ED features was 2.2% (N = 57) among mothers, <1% in siblings, and not present in fathers. We restricted our analyses to mothers. Compared to mothers with no history of ED, those with a history of ED had significantly higher scores on the BAP-Q Total Score and each of the three BAP-Q domains. More importantly, when the BAP-Q was used as a classification tool, we found that when compared to mothers with no history of ED, those with a history of ED were most likely to fall into the clinically significant range on the BAP-Q Rigid domain. Our results suggest that a history of ED features among mothers of individuals with autism is associated with the presence of autistic traits. This extends previous work showing a relationship between autism and ED and expands the range of neuropsychiatric traits that have relevance to the BAP among family members of individuals with autism. LAY SUMMARY: Using information from the Simons Simplex Collection we tested whether mothers of individuals with autism with a history of eating disorder had more autism traits (i.e., similar to those in autism but milder) compared to mothers with no history of eating disorder. The most striking difference between the groups was the presence of rigidity in mothers with a history of eating disorder. This extends previous work showing a relationship between autism and eating disorders and suggests the utility of studying eating disorders in future family studies of autism. Autism Res 2020, 13: 1573-1581. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.
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Affiliation(s)
| | | | - Joycelyn M Lee
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Nicole D Dueker
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Eden R Martin
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Margaret A Pericak-Vance
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Michael Cuccaro
- University of Miami Miller School of Medicine, Miami, FL, USA.,John P. Hussman Institute for Human Genomics, University of Miami Miller School of Medicine, Miami, FL, USA
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Vuillier L, Carter Z, Teixeira AR, Moseley RL. Alexithymia may explain the relationship between autistic traits and eating disorder psychopathology. Mol Autism 2020; 11:63. [PMID: 32758290 PMCID: PMC7406391 DOI: 10.1186/s13229-020-00364-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Autistic people are disproportionately vulnerable to anorexia nervosa and other eating disorders (ED), and within the general population, autistic traits correlate with ED psychopathology. A putative mechanism which may underpin this heightened risk is alexithymia, a difficulty identifying and describing emotional states which is observed in both autism and ED. In two experiments with independent non-clinical samples, we explored whether alexithymia might mediate the heightened risk of eating psychopathology in individuals high in autistic traits. METHODS Our first experiment used the PROCESS macro for SPSS to examine relationships between alexithymia (measured by the Toronto Alexithymia Scale (TAS-20)), autistic traits (autism quotient (AQ)), and eating psychopathology (Eating Attitudes Test (EAT-26)) in 121 participants. Our second experiment (n = 300) replicated and furthered this analysis by examining moderating effects of sex and controlling for anxiety and depression as covariates. We also included an additional performance-based measure of alexithymia, the Levels of Emotional Awareness Scale (LEAS). RESULTS Study 1 suggested that TAS-20 scores mediated the relationship between heightened autistic traits and eating psychopathology. Replication and further scrutiny of this finding, in study 2, revealed that this mediation effect was partial and specific to the female participants in this sample. The mediation effect appeared to be carried by the difficulty identifying feelings subscale of the TAS-20, even when depression and anxiety were controlled for. LEAS scores, however, were not significantly related to autistic traits or eating psychopathology. LIMITATIONS Cross-sectional data prevents any conclusions around the direction and causality of relationships between alexithymia, autistic traits, and eating psychopathology (alongside depression and anxiety), necessitating longitudinal research. Our non-clinical sample was predominantly Caucasian undergraduate students, so it remains to be seen if these results would extrapolate to clinical and/or autistic samples. Divergence between the TAS-20 and LEAS raises crucial questions regarding the construct validity of these measures. CONCLUSIONS Our findings with respect to autistic traits suggest that alexithymia could partially explain the prevalence of ED in autistic people and may as such be an important consideration in the pathogenesis and treatment of ED in autistic and non-autistic people alike. Further research with clinical samples is critical to explore these ideas. Differences between men and women, furthermore, emphasize the importance of looking for sex-specific as well as generic risk factors in autistic and non-autistic men and women.
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Affiliation(s)
- L. Vuillier
- Department of Psychology, Bournemouth University, Poole, UK
| | - Z. Carter
- Department of Psychology, Bournemouth University, Poole, UK
| | - A. R. Teixeira
- Department of Psychology, Bournemouth University, Poole, UK
| | - R. L. Moseley
- Department of Psychology, Bournemouth University, Poole, UK
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Bentz M, Westwood H, Jepsen JRM, Plessen KJ, Tchanturia K. The autism diagnostic observation schedule: Patterns in individuals with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2020; 28:571-579. [PMID: 32729156 DOI: 10.1002/erv.2757] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 05/04/2020] [Accepted: 06/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Studies have used the Autism Diagnostic Observation Schedule (the ADOS-2) in individuals with anorexia nervosa (AN), but the patterns of scores have not been assessed. We examined which subset of the ADOS-2 items best discriminate individuals with AN from healthy controls (HC), and assessed the potential clustering of AN participants based on different profiles of the ADOS-2 item scores. METHOD We combined datasets from two previous studies, and (a) compared mean ranks between young AN participants (N = 118) and HC (N = 42), (ii) replicated the item selection procedure of the existing ADOS-2 algorithm to assess sensitivity of items in the AN group, and (c) applied a two-step clustering analysis in the AN group (N = 149). RESULTS AN participants displayed significantly higher mean ranks than HC participants in five of 32 items. All five items are part of the existing ADOS-2 algorithm. We found two clusters of AN participants; one representing normal social behaviour, comprising 68% of the individuals with AN, and one representing less efficient social behaviour, comprising 32% of individuals with AN. CONCLUSIONS The items comprising the social affective cluster of the existing ADOS-2 algorithm are well suited to assess difficulties with social functioning in individuals with AN.
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Affiliation(s)
- Mette Bentz
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Heather Westwood
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jens Richardt Møllegaard Jepsen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
- Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS) and Center for Neuropsychiatric Schizophrenia Research (CNSR), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Kerstin Jessica Plessen
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Kate Tchanturia
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Dandil Y, Smith K, Kinnaird E, Toloza C, Tchanturia K. Cognitive Remediation Interventions in Autism Spectrum Condition: A Systematic Review. Front Psychiatry 2020; 11:722. [PMID: 32793009 PMCID: PMC7393993 DOI: 10.3389/fpsyt.2020.00722] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Autism spectrum condition (ASC) is a lifelong neurodevelopmental condition characterized by difficulties in social cognition and heterogeneity of executive function which are suggested to be underpinned by neurobiological, prenatal and genetic factors. Cognitive remediation (CR) interventions are frequently used to address cognitive characteristics and improve cognitive and general functioning. However, the evidence is limited for ASC. This systematic review is the first to provide a narrative synthesis of all studies of CR interventions and ASC. The review aimed to delineate the development of research in this area in both adolescents and adults, with implications for clinical practice and future research. METHOD The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The literature was reviewed using the PubMed, PsycINFO, Web of Science, Scopus and Embase from inception to 1st April 2020. Out of 1,503 publications, a total of 13 papers were identified as being relevant for the review. RESULTS The 13 studies meeting the inclusion criteria were: four randomized control trials (RCTs); two non-randomized control trials, four case series, two feasibility studies and one case study. A narrative synthesis of the data suggested that CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. RCTs supported the efficacy of CR interventions in improving social cognition and executive functioning. Non-randomized control trials provided evidence for the effectiveness of social cognition remediation interventions in ASC. Case series and a case study have also supported the feasibility of CR interventions, including reflections on their adaptation for ASC populations and the positive feedback from participants. CONCLUSIONS CR interventions are potentially effective in improving social cognition and cognitive functioning in ASC. However, the generalizability of the included empirical studies was hampered by several methodological limitations. To further strengthen understandings of the effectiveness of CR interventions for ASC, future RCTs are needed with larger sample sizes in exploring the long-term effectiveness of CR interventions, using age-appropriate valid and reliable outcome measures. They should also consider the heterogeneity in neuropsychological functioning in ASC and the mediating and moderating mechanisms of the CR intervention for ASC.
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Affiliation(s)
- Yasemin Dandil
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
| | - Cindy Toloza
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Department of Psychology, Illia State University, Tbilisi, Georgia
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Tchanturia K, Smith K, Glennon D, Burhouse A. Towards an Improved Understanding of the Anorexia Nervosa and Autism Spectrum Comorbidity: PEACE Pathway Implementation. Front Psychiatry 2020; 11:640. [PMID: 32733294 PMCID: PMC7358367 DOI: 10.3389/fpsyt.2020.00640] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/19/2020] [Indexed: 12/13/2022] Open
Abstract
This paper describes an eating disorder service development pilot project helping clinicians implement evidence-based research for patients with anorexia nervosa and autism spectrum condition comorbidity. Currently, there are no clear guidelines or recommendations for people who have the developmental condition of autism spectrum condition and a comorbid eating disorder. The Maudsley eating disorder team is pioneering a tailored approach of adaptations for this autism and eating disorder comorbidity to improve and adapt evidenced-based treatments and improve the experience for patients, families, and clinicians involved in their care. This paper aims to support the clinical and research community to implement some of the learning and new strategies developed through the PEACE pathway. The authors aim is to collaborate with teams nationally and internationally to scale up the project to benefit patients with this comorbidity.
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Affiliation(s)
- Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Katherine Smith
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Danielle Glennon
- National Eating Disorder Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Burhouse
- Northumbria Healthcare NHS Foundation Trust, Patient Experience Department, Wansbeck General Hospital, Ashington, United Kingdom
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Brown CM, Stokes MA. Intersection of Eating Disorders and the Female Profile of Autism. Child Adolesc Psychiatr Clin N Am 2020; 29:409-417. [PMID: 32169270 DOI: 10.1016/j.chc.2019.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
There is a moderate degree of comorbidity between autism and eating disorders, particularly anorexia nervosa in female individuals. Research indicates that up to 30% of patients with anorexia are autistic, or display high levels of autistic traits. Frequently, an autism diagnosis is secondary to an eating disorder diagnosis, which brings concomitant issues into treatment efficacy and outcomes for both conditions. Less is known about comorbidity with other eating disorder subtypes. Autistic traits can impede standard approaches to eating disorder treatment. Treatment options and settings may need to be modified to better accommodate autistic female individuals.
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Affiliation(s)
- Claire M Brown
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia
| | - Mark A Stokes
- Deakin University, School of Psychology, Faculty of Health, 221 Burwood Highway, Burwood, Victoria 3125, Australia.
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The Female Autism Phenotype and Camouflaging: a Narrative Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020. [DOI: 10.1007/s40489-020-00197-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
AbstractAutism is more commonly diagnosed in males than females. One explanation is the ‘female protective effect’: there is something inherent in being female which reduces the likelihood of developing autism. However, evidence suggests that the condition is underdiagnosed in females, perhaps because females express their autism in ways which do not meet current diagnostic criteria. This review explores evidence for a female-typical autism presentation, the Female Autism Phenotype (FAP) and the component of camouflaging (compensating for and masking autistic characteristics) in particular. The evidence so far supports the existence of a female-typical autism presentation, although further examination of the characteristics and their impact across all genders and ages is needed.
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Kinnaird E, Sedgewick F, Stewart C, Tchanturia K. Exploring Self-Reported Eating Disorder Symptoms in Autistic Men. AUTISM IN ADULTHOOD 2019; 1:306-310. [PMID: 36601317 PMCID: PMC8992817 DOI: 10.1089/aut.2019.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Although research suggests a relationship between restrictive eating disorders (EDs) and autism, there is a lack of research in this area from the perspective of autistic men. Our aim was to explore whether ED symptoms are heightened in autistic men compared with nonautistic men. Methods We recruited 103 autistic and nonautistic participants through an online study. We assessed ED symptoms, autistic features, anxiety, depression, and body mass index (BMI) using self-report measures. Results Autistic men (n = 54) exhibited significantly higher levels of ED symptoms in the areas of eating (p < 0.001), shape (p = 0.005), and weight (p = 0.001) concerns, and the global score (p = 0.046) than nonautistic men (n = 49). However, autistic men scored significantly lower in the area of dietary restraint (p = 0.032). Global ED scores did not correlate with autistic traits, but did correlate with anxiety (p < 0.001) and BMI (p < 0.001) in the autistic group. Conclusions This exploratory study suggests that heightened ED symptoms in autistic men may be related to heightened levels of anxiety and higher BMIs, rather than autistic traits. It also highlights that autistic men may experience symptoms not relating to dietary restraint. Future research should consider further exploring the relationship between anxiety, BMI, and disordered eating in autism. Lay Summary Why was this study done?: There is a lot of interest in the relationship between autism and eating disorders (EDs). Research suggests that as many as one in four people with anorexia could be autistic. However, most research has been done (1) on women and (2) looking at autistic traits in women with anorexia. There is less research looking at the relationship from the perspective (1) of men and (2) looking at ED symptoms in autistic people.What was the purpose of this study?: We aimed to explore whether autistic men experience more ED symptoms than nonautistic men.What did the researchers do?: This was an online study. We asked participants to fill out self-report measures of autistic traits and ED symptoms. We also asked participants to self-report whether they were autistic, and whether they had been previously diagnosed with an ED. We included 54 autistic men and 49 nonautistic men.What were the results of the study?: We found that although autistic men did experience higher levels of ED symptoms than nonautistic men, this did not appear to be related to autistic traits. Instead ED symptoms were related to anxiety and higher rates of being overweight or obese. In addition, autistic men in fact experienced significantly lower levels of ED symptoms associated with dietary restraint than nonautistic men.What do these findings add to what was already known?: Our findings reflect some previous research findings that ED symptoms may be heightened in autistic people. They also suggest that these symptoms are related to higher levels of anxiety or body mass indexes (BMIs) in autistic people, rather than autistic traits themselves. Also, most previous research has focused on symptoms of restraint in EDs and autism, for example, limiting the amount you eat or not eating certain foods. In our study, restraint was not found to be heightened, suggesting that focusing on restraint symptoms might be less relevant to autistic men.What are potential weaknesses in the study?: One key weakness is our use of self-report measures, particularly asking participants to self-report their autism diagnosis. An additional limitation is the small sample size, which makes it hard to generalize findings.How will these findings help autistic adults now or in the future?: More research is needed to understand the relationship between anxiety, BMI, autism, and ED symptoms. Our findings could help our understanding of disordered eating in autistic adults as they suggest we need to pay more attention to autistic adults experiencing ED symptoms that are not related to dietary restriction, such as binge eating.
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Affiliation(s)
- Emma Kinnaird
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Felicity Sedgewick
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Catherine Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Kate Tchanturia
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Illia State University, Tbilisi, Georgia
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The sex-specific association between autistic traits and eating behavior in childhood: An exploratory study in the general population. Appetite 2019; 147:104519. [PMID: 31738945 DOI: 10.1016/j.appet.2019.104519] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Revised: 10/19/2019] [Accepted: 11/13/2019] [Indexed: 12/22/2022]
Abstract
Children with Autism Spectrum Disorder (ASD) often exhibit problematic eating behaviors, an observation mostly based on male dominated, clinical ASD study samples. It is, however, important to evaluate both children with an ASD diagnosis and children with subclinical autistic traits as both often experience difficulties. Moreover, considering the suggestion of a possible girl-specific ASD phenotype, there is a need to determine whether autistic traits are related with problematic eating behaviors in girls as well. This study explores the sex-specific association between autism (both autistic traits and diagnosed ASD) and eating behavior in middle childhood in Generation R, a prospective population-based cohort from fetal life onwards. We collected parental reports of autistic traits at six years (Social Responsiveness Scale) and of eating behavior at ten years (Children's Eating Behaviour Questionnaire). In this cohort of 3559 children, autistic traits at six years were associated with more Picky Eating, Emotional Eating and Food Responsiveness in later childhood (e.g. adjusted B for Picky Eating = 0.07; 95% CI: 0.03, 0.11). Stratified analyses showed that in girls, autistic traits were associated with more Emotional Overeating and Emotional Undereating (e.g. adjusted B for Emotional Undereating = 0.12; 95% CI: 0.04, 0.20), while no associations were found for boys. Results comparing children with and without an ASD diagnosis in the cohort largely confirm these associations (e.g. in girls, adjusted B for Emotional Undereating = 0.72; 95% CI: 0.01, 1.42). Our results point to a sex-specific association between autism and eating behavior in middle childhood. Also, our study is the first study to show that autistic traits are associated with emotionally based eating problems in girls and possibly represent part of a girl-specific ASD phenotype.
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Fornaro M, Sassi T, Novello S, Anastasia A, Fusco A, Senatore I, de Bartolomeis A. Prominent autistic traits and subthreshold bipolar/mixed features of depression in severe anorexia nervosa. ACTA ACUST UNITED AC 2019; 42:153-161. [PMID: 31691722 PMCID: PMC7115451 DOI: 10.1590/1516-4446-2019-0500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 07/22/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Autistic traits are associated with a burdensome clinical presentation of anorexia nervosa (AN), as is AN with concurrent depression. The aim of the present study was to explore the intertwined association between complex psychopathology combining autistic traits, subthreshold bipolarity, and mixed depression among people with AN. METHOD Sixty patients with AN and concurrent major depressive episode (mean age, 22.2±7 years) were cross-sectionally assessed using the Autism-Spectrum Quotient test (AQ-test), the Hamilton depression scales for depression and anxiety, the Young Mania Rating Scale (YMRS), the Hypomania-Checklist-32 (HCL-32), second revision (for subthreshold bipolarity), the Brown Assessment and Beliefs Scale (BABS), the Yale-Brown-Cornell Eating Disorders Scale (YBC-EDS), and the Eating Disorder Examination Questionnaire (EDE-Q). Cases were split into two groups depending on body mass index (BMI): severe AN (AN+) if BMI < 16, not severe (AN-) if BMI ≥ 16. RESULTS The "subthreshold bipolarity with prominent autistic traits" pattern correctly classified 83.6% of AN patients (AN+ = 78.1%; AN- = 91.3%, Exp(B) = 1.391). AN+ cases showed higher rates of positive scores for YMRS items 2 (increased motor activity-energy) and 5 (irritability) compared to AN- cases. CONCLUSIONS In our sample, depressed patients with severe AN had more pronounced autistic traits and subtly mixed bipolarity. Further studies with larger samples and prospective follow-up of treatment outcomes are warranted to replicate these findings.
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Affiliation(s)
- Michele Fornaro
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Teresa Sassi
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Stefano Novello
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | | | - Andrea Fusco
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Ignazio Senatore
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
| | - Andrea de Bartolomeis
- Dipartimento di Neuroscienze, Sezione di Psichiatria, Università Federico II di Napoli, Italy
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Nickel K, Maier S, Endres D, Joos A, Maier V, Tebartz van Elst L, Zeeck A. Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2019; 10:708. [PMID: 31649563 PMCID: PMC6796791 DOI: 10.3389/fpsyt.2019.00708] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Links between eating disorders (EDs) [e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] and the major neurodevelopmental disorders of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs. Methods: We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD. Results: The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD. Conclusions: Studies on the prevalence rates of EDs in ADHD and ASD and vice versa are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and neurodevelopmental disorders. Furthermore, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or nonspecific predisposing factors for the development of EDs.
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Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Viktoria Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Lawson LP, Joshi R, Barbaro J, Dissanayake C. Gender Differences During Toddlerhood in Autism Spectrum Disorder: A Prospective Community-Based Longitudinal Follow-Up Study. J Autism Dev Disord 2019; 48:2619-2628. [PMID: 29497988 DOI: 10.1007/s10803-018-3516-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Relatively few studies have examined gender differences in infants and toddlers, and most focus on clinically referred samples or high-risk infant cohorts. The current study aimed to examine gender differences in early autism manifestations and cognitive development in a community-ascertained sample. In total, 46 males and 21 females with ASD were seen at approximately 24 and 48 months of age. No significant gender differences were observed on overall cognitive ability, verbal skills, non-verbal skills, overall autism severity, or restricted repetitive behaviours. However, females were found to exhibit more social communication impairments than males. These findings may indicate that female toddlers with less severe or different, social communication impairments may be more likely to be missed during routine surveillance during toddlerhood.
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Affiliation(s)
- Lauren P Lawson
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia.
- Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Australia.
| | - Rucha Joshi
- Autism Spectrum Australia, Melbourne, Australia
| | - Josephine Barbaro
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia
| | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Kingsbury Drive, Melbourne, VIC, 3086, Australia
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Garel N, Garel P. Diagnosis of Autism Spectrum Disorder in Adolescents with Complex Clinical Presentations: A Montreal Case Series. ADOLESCENT PSYCHIATRY 2019. [DOI: 10.2174/2210676609666181204125951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background:
Despite increased attention and recognition of autism spectrum
disorders, many patients suffering from these disorders remain undiagnosed or are diagnosed
late due to their subtle clinical presentation. The challenge for clinicians working in the field
of mental health is not in screening and diagnosing young children showing typical signs of
autism spectrum disorders, but rather in identifying patients at the high-functioning end of
the spectrum whose intellectual abilities mask their social deficits.
Objective:
Because therapeutic interventions differ radically once the diagnosis of ASD has
been made, it is important to understand the trajectory of those adolescents and identify clues
that could help raise the diagnosis of ASD earlier.
Methods:
Records of eight adolescents with a late diagnosis of ASD were retrospectively
reviewed to identify relevant clinical features that were overlooked in childhood and early
adolescence.
Results:
The patients were previously misdiagnosed with multiple mental health disorders.
These cases showed striking similarities in terms of developmental history, reasons for
misdiagnosis, and the clinical picture at the time of ASD recognition. The cases were
characterized by complex and fluctuating symptomatology, including depression, anxiety,
behavioural problems, self-injurious behaviour and suicidal thoughts. Their Autism
Spectrum Disorder (ASD) went previously undiagnosed due to the individual’s intelligence
and learning abilities, which masked their social deficits and developmental irregularities.
Signs of ASD were continuously present since childhood in all the eight cases. Once the
developmental histories and the psychiatric evaluation of these adolescents were done by
psychiatrists with appropriate knowledge of autism, the diagnosis of ASD was made.
Conclusion:
The ASD hypothesis should be raised in the presence of confusing symptoms
that do not respond to usual treatment and are accompanied by an irregular developmental
background. It is indeed a difficult diagnosis to make; however, the focused clinician can
note subtle signs of ASD despite the intellectual learning of social codes. Family history,
developmental irregularities, rigidity, difficulty in spontaneously understanding emotions,
discomfort in groups and the need to be alone are significant indicators to recognize. Once
the diagnosis has been considered, it must be confirmed or rejected by an experienced
multidisciplinary team. The challenge for clinicians working in the field of mental health is
not in screening and diagnosing young children showing typical signs of ASD, but rather in
identifying patients who are at high-functioning end of the spectrum whose intellectual
abilities mask their social deficits.
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Affiliation(s)
| | - Patricia Garel
- Sainte-Justine University Health Center, University of Montreal, Montreal, Quebec, Canada
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Assessing Autism in Adults: An Evaluation of the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult). J Autism Dev Disord 2019; 48:549-560. [PMID: 29116420 PMCID: PMC5807495 DOI: 10.1007/s10803-017-3321-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We developed a brief, informant-report interview for assessing autism spectrum conditions (ASC) in adults, called the Developmental, Dimensional and Diagnostic Interview-Adult Version (3Di-Adult); and completed a preliminary evaluation. Informant reports were collected for participants with ASC (n = 39), a non-clinical comparison group (n = 29) and a clinical comparison group (n = 20) who had non-autistic mental health conditions. Mean administration time was 38 min (50 min for ASC). Internal consistency (αs ≥ 0.93) and inter-rater agreement (ICCs ≥ 0.99) were high. When discriminating ASC from non-ASC, the 3Di-Adult showed excellent sensitivity (95%) and specificity (92%). The 3Di-Adult shows promise as a psychometrically sound and time-efficient interview for collecting standardised informant reports for DSM-5 assessments of ASC in adults, in research and clinical practice.
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Assessing ASD in Adolescent Females with Anorexia Nervosa using Clinical and Developmental Measures: a Preliminary Investigation. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 46:183-192. [PMID: 28417276 PMCID: PMC5770498 DOI: 10.1007/s10802-017-0301-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The aim of this study was to use standardised, clinical assessment tools to explore the presence of Autism Spectrum Disorder (ASD) symptoms in a sample of adolescent females with Anorexia Nervosa (AN), receiving either day-patient or inpatient treatment for their eating disorder and to determine whether any such symptoms were present during the early developmental period, a requirement for a diagnosis of ASD. Using a cross-sectional design, 40 females aged between 12 and 18 were recruited from inpatient and day-patient eating disorder services. All participants had a diagnosis of AN and were assessed for symptoms of ASD using the Autism Diagnostic Observation Schedule, 2nd edition (ADOS-2). If participants scored at or above clinical cut-off on the ADOS-2, their parents were asked to complete the Developmental, Dimensional and Diagnostic Interview, short version (3Di-sv). Of the 40 participants assessed, 21 scored above cut-off on the ADOS-2. When developmental history was obtained, only four participants scored above cut-off on all sub-scales of the 3Di-sv, thus meeting full research criteria for ASD. This study suggests that 10% of adolescents with AN from inpatient or day-patient settings may have diagnosable ASD, while a further 40% may show symptoms of ASD, which may arise from the ill-state of AN or are not supported by parental report.
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Kucharska K, Kulakowska D, Starzomska M, Rybakowski F, Biernacka K. The improvement in neurocognitive functioning in anorexia nervosa adolescents throughout the integrative model of psychotherapy including cognitive remediation therapy. BMC Psychiatry 2019; 19:15. [PMID: 30626367 PMCID: PMC6327421 DOI: 10.1186/s12888-018-1984-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients with anorexia nervosa (AN) experience difficulties in neurocognitive functioning in the acute phase of illness which might be related to clinical presentation, but also in the apparently remitted state after weight recovery. Among the most commonly reported persistent deficits is cognitive inflexibility, which can be interpreted as a vulnerability trait or a "neuropsychological scar" reflecting the detrimental effect of prolonged semi-starvation in patients with a long duration of illness. Studies of adolescent samples with a relatively short clinical course may enable avoiding the effect of prolonged illness and help to determine whether neuropsychological deficits are trait or state dependent. The aim of this study is to assess cognitive functioning in adolescents with AN before and after the inpatient treatment programme, including cognitive remediation therapy (CRT). METHODS Forty-seven adolescent female inpatients with AN diagnosed according to DSM-5 and fifty healthy female adolescents matched for the education level and age were recruited. The patients underwent a multimodal treatment including a ten-week CRT. The standardized and cross-validated neuropsychological (Trail Making Test - TMT A and B, Color-Word Stroop Task - CWST, Ruff Figural Fluency Test - RFFT) and clinical measurements (Beck Depression Inventory - BDI, Eating Attitude Test - EAT-26, Yale-Brown Obsessive Compulsive Scale - Y-BOCS) were used to assess both clinical (in the acute phase and after partial weight recovery) and control subjects. RESULTS Initially, AN patients performed significantly worse compared to the controls, but afterwards, inpatient treatment improvement was noted on all examined measures. In a few subtests (TMT, CWST) performance of AN patients after the programme was still significantly poorer than in HC. CONCLUSIONS Cognitive inflexibility in adolescent AN patients, as measured with TMT, CWST, and RFFT tends to improve after therapy. Nevertheless, a few neuropsychological subtests which did not show complete normalization may warrant attention in subsequent studies. Further research including control intervention is needed to conclude whether CRT intervention affects the outcome.
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Affiliation(s)
- K. Kucharska
- 0000 0001 2237 2890grid.418955.4The Specialist Eating Disorder Unit, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - D. Kulakowska
- 0000 0001 2237 2890grid.418955.4The Specialist Eating Disorder Unit, Institute of Psychiatry and Neurology, Warsaw, Poland
| | - M. Starzomska
- 0000 0001 2301 5211grid.440603.5Institute of Psychology, Faculty of Christian Philosophy, Cardinal Stefan Wyszynski University in Warsaw, Warsaw, Poland
| | - F. Rybakowski
- 0000 0001 2205 0971grid.22254.33The Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland
| | - K. Biernacka
- 0000 0001 2237 2890grid.418955.4The Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Neurology, 9 Sobieski, 02-957 Warsaw, Poland
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Karjalainen L, Råstam M, Paulson-Karlsson G, Wentz E. Do autism spectrum disorder and anorexia nervosa have some eating disturbances in common? Eur Child Adolesc Psychiatry 2019; 28:69-78. [PMID: 29974245 PMCID: PMC6349794 DOI: 10.1007/s00787-018-1188-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/28/2018] [Indexed: 11/24/2022]
Abstract
A possible overlap between autism spectrum disorder (ASD) and anorexia nervosa (AN), in terms of both behavioural and cognitive features, has led to new areas of research. The aim of the present study was to examine the occurrence of eating behaviours frequently seen in ASD among adolescents and young adults with AN. The participants were females within the age range 15-25 years: 36 with current AN (32 were followed up after 1 year), 19 with ASD, and 30 healthy females. The participants completed the SWedish Eating Assessment for Autism spectrum disorders (SWEAA) and the Autism Spectrum Quotient tool (AQ). AN groups had significantly higher SWEAA scores than the healthy comparison group, also when patients had gained weight. Typical autistic eating behaviours, such as selective eating, were more common in the AN groups than in the ASD group. This is the first time that SWEAA has been implemented in an AN population. Eating behaviours frequently seen in ASD seem to be frequent in AN and some remain also after weight gain.
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Affiliation(s)
- Louise Karjalainen
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE-41119, Göteborg, Sweden.
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Kungsgatan 12, SE-41119 Göteborg, Sweden ,Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Gunilla Paulson-Karlsson
- Anorexia-Bulimia Unit, The Queen Silvia Children’s University Hospital, Göteborg, Sweden ,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elisabet Wentz
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Göteborg, Sweden
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Margari L, Palumbi R, Peschechera A, Craig F, de Giambattista C, Ventura P, Margari F. Sex-Gender Comparisons in Comorbidities of Children and Adolescents With High-Functioning Autism Spectrum Disorder. Front Psychiatry 2019; 10:159. [PMID: 30971962 PMCID: PMC6445051 DOI: 10.3389/fpsyt.2019.00159] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 03/04/2019] [Indexed: 01/18/2023] Open
Abstract
Over the last few years, new studies focused their attention on the gender-related features in high-functioning autism spectrum disorder (HFA), often leading to controversial results. Another interesting aspect of these subtype of patients is linked to the complexity of clinical presentation, where besides core symptoms, other co-occurrence disorders may complicate the diagnostic evaluation. Therefore, we retrospectively studied 159 HFA patients, male and female, investigating their comorbidities and to find any gender difference. For each patient, were evaluated the presence/absence, type and gender distribution of psychopathological comorbidities, according to DSM-5 diagnostic criteria. The total sample was divided in 100 male and 59 female patients, age and intelligence quotient matched. In our sample, the psychiatric comorbidities observed were Attention Deficit Hyperactivity Disorder, Anxiety Disorders, Depressive Disorders, Bipolar Disorder, Obsessive-Compulsive Disorder, and Anorexia Nervosa. No statistical significant differences were found between male and female HFA patients comorbidities except for Anorexia Nervosa. In both male and female patients, attention deficit and hyperactivity disorder and anxiety disorders were found in high percentage. In conclusion, our investigation showed that a statistical significant difference of comorbidity between male and female HFA patients was found only for AN diagnosis. However, the question about the distinction between female and male HFA patients remains quite interesting and an open area of research for future studies.
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Affiliation(s)
- Lucia Margari
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Palumbi
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Antonia Peschechera
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Craig
- Unit for Severe Disabilities in Developmental Age and Young Adults, Developmental Neurology and Neurorehabilitation, Scientific Institute IRCCS E. Medea, Brindisi, Italy
| | - Concetta de Giambattista
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Patrizia Ventura
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
| | - Francesco Margari
- Basic Medical Sciences Neuroscience and Sense Organs Department, University of Bari Aldo Moro, Bari, Italy
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Antezana L, Factor RS, Condy EE, Strege MV, Scarpa A, Richey JA. Gender differences in restricted and repetitive behaviors and interests in youth with autism. Autism Res 2018; 12:274-283. [PMID: 30561911 DOI: 10.1002/aur.2049] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/05/2018] [Accepted: 09/29/2018] [Indexed: 12/15/2022]
Abstract
Previous work has found gender differences in restricted and repetitive behaviors and interests (RRBI) for autism spectrum disorder (ASD). Compared to girls, affected boys have increased stereotyped and restricted behaviors; however much less is known about gender differences in other areas of RRBI. This study aims to identify whether specific RRBI (i.e., stereotyped, self-injurious, compulsive, insistence on sameness, ritualistic, and restricted), as measured by item-level data on the Repetitive Behavior Scale-Revised (RBS-R), can distinguish girls from boys with ASD. Participants included 615 individuals with ASD (507 boys; 82.4%), ages 3-18 years of age (M = 10.26, SD = 4.20), who agreed to share data with the National Database for Autism Research (NDAR). Multivariate analysis of variance and discriminant function analysis (DFA) were used to determine whether item-level RBS-R data could correctly classify cases by gender. DFA results suggest that RBS-R items significantly differentiate gender. Strongly differentiating RBS-R items had greater success in correctly classifying affected boys (67.90%) than girls (61.00%). Items that best-discriminated gender were heightened stereotyped behaviors and restricted interests items in boys and compulsive, sameness, restricted, and self-injurious behavior items in girls. This study is the first to find that girls with ASD may have increased compulsive, sameness, and restricted RRBI compared to boys. Additionally, findings support heightened self-injurious behaviors in affected girls. Future research should disentangle whether elevated rates of RRBI in girls are central to the presentation of ASD in girls or an epiphenomenon of the high rates of co-occurring disorders (e.g., anxiety) noted in girls. Autism Res 2019, 12: 274-283 © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study is the first to examine a comprehensive measure of repetitive behavior in children with autism, with findings of increased compulsive, insistence on sameness, and self-injurious behavior characterizing girls and increased stereotyped and restricted behavior characterizing boys. Future research should determine whether these elevated behaviors in girls are directly part of the autism presentation in girls or symptoms of co-occurring psychopathology. It is important for autism diagnostic measures to best capture the types of repetitive behavior girls may demonstrate.
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Affiliation(s)
- Ligia Antezana
- Department of Psychology, Virginia Tech, Blacksburg, Virginia.,Virginia Tech Center for Autism Research, Blacksburg, Virginia
| | - Reina S Factor
- Department of Psychology, Virginia Tech, Blacksburg, Virginia.,Virginia Tech Center for Autism Research, Blacksburg, Virginia
| | - Emma E Condy
- Department of Psychology, Virginia Tech, Blacksburg, Virginia
| | | | - Angela Scarpa
- Department of Psychology, Virginia Tech, Blacksburg, Virginia.,Virginia Tech Center for Autism Research, Blacksburg, Virginia
| | - John A Richey
- Department of Psychology, Virginia Tech, Blacksburg, Virginia.,Virginia Tech Center for Autism Research, Blacksburg, Virginia
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Tint A, Hamdani Y, Sawyer A, Desarkar P, Ameis SH, Bardikoff N, Lai MC. Wellness Efforts for Autistic Women. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018. [DOI: 10.1007/s40474-018-0148-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Abstract
PURPOSE OF REVIEW Neurodevelopmental disorders disproportionately affect males. The mechanisms underlying male vulnerability or female protection are not known and remain understudied. Determining the processes involved is crucial to understanding the etiology and advancing treatment of neurodevelopmental disorders. Here, we review current findings and theories that contribute to male preponderance of neurodevelopmental disorders, with a focus on autism. RECENT FINDINGS Recent work on the biological basis of the male preponderance of autism and other neurodevelopmental disorders includes discussion of a higher genetic burden in females and sex-specific gene mutations or epigenetic changes that differentially confer risk to males or protection to females. Other mechanisms discussed are sex chromosome and sex hormone involvement. Specifically, fetal testosterone is involved in many aspects of development and may interact with neurotransmitter, neuropeptide, or immune pathways to contribute to male vulnerability. Finally, the possibilities of female underdiagnosis and a multi-hit hypothesis are discussed. This review highlights current theories of male bias in developmental disorders. Topics include environmental, genetic, and epigenetic mechanisms; theories of sex chromosomes, hormones, neuroendocrine, and immune function; underdiagnosis of females; and a multi-hit hypothesis.
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Affiliation(s)
- Sarah L. Ferri
- Department of Molecular Physiology and Biophysics, Iowa Neuroscience Institute, University of Iowa, Pappajohn Biomedical Discovery Building, 169 Newton Road, Iowa City, IA 52242 USA
| | - Ted Abel
- Department of Molecular Physiology and Biophysics, Iowa Neuroscience Institute, University of Iowa, Pappajohn Biomedical Discovery Building, 169 Newton Road, Iowa City, IA 52242 USA
| | - Edward S. Brodkin
- Center for Neurobiology and Behavior, Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Translational Research Laboratory, 125 South 31 Street, Room 2202, Philadelphia, PA 19104-3403 USA
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Björnsdotter M, Davidovic M, Karjalainen L, Starck G, Olausson H, Wentz E. Grey matter correlates of autistic traits in women with anorexia nervosa. J Psychiatry Neurosci 2018; 43:79-86. [PMID: 29481315 PMCID: PMC5837888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Patients with anorexia nervosa exhibit higher levels of behaviours typically associated with autism-spectrum disorder (ASD), but the neural basis is unclear. We sought to determine whether elevated autistic traits in women with anorexia nervosa may be reflected in cortical morphology. METHODS We used voxel-based morphometry (VBM) to examine regional grey matter volumes in high-resolution MRI structural brain scans in women with anorexia nervosa and matched healthy controls. The Autism-spectrum Quotient (AQ) scale was used to assess autistic traits. RESULTS Women with anorexia nervosa (n = 25) had higher AQ scores and lower bilateral superior temporal sulcus (STS) grey matter volumes than the control group (n = 25). The AQ scores correlated negatively with average left STS grey matter volume in women with anorexia nervosa. LIMITATIONS We did not control for cognitive ability and examined only women with ongoing anorexia nervosa. CONCLUSION Elevated autistic traits in women with anorexia nervosa are associated with morphometric alterations of brain areas linked to social cognition. This finding provides neurobiological support for the behavioural link between anorexia nervosa and ASD and emphasizes the importance of recognizing autistic traits in preventing and treating anorexia nervosa.
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Affiliation(s)
- Malin Björnsdotter
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Monika Davidovic
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Louise Karjalainen
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Göran Starck
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Håkan Olausson
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Elisabet Wentz
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
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Hull L, Petrides KV, Allison C, Smith P, Baron-Cohen S, Lai MC, Mandy W. "Putting on My Best Normal": Social Camouflaging in Adults with Autism Spectrum Conditions. J Autism Dev Disord 2018; 47:2519-2534. [PMID: 28527095 PMCID: PMC5509825 DOI: 10.1007/s10803-017-3166-5] [Citation(s) in RCA: 388] [Impact Index Per Article: 64.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Camouflaging of autistic characteristics in social situations is hypothesised as a common social coping strategy for adults with autism spectrum conditions (ASC). Camouflaging may impact diagnosis, quality of life, and long-term outcomes, but little is known about it. This qualitative study examined camouflaging experiences in 92 adults with ASC, with questions focusing on the nature, motivations, and consequences of camouflaging. Thematic analysis was used to identify key elements of camouflaging, which informed development of a three-stage model of the camouflaging process. First, motivations for camouflaging included fitting in and increasing connections with others. Second, camouflaging itself comprised a combination of masking and compensation techniques. Third, short- and long-term consequences of camouflaging included exhaustion, challenging stereotypes, and threats to self-perception.
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Affiliation(s)
- Laura Hull
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK.
- Department of Psychology, University College London, 26 Bedford Way, London, WC1H 0AP, UK.
| | - K V Petrides
- London Psychometric Laboratory, University College London, London, UK
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Paula Smith
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Meng-Chuan Lai
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK
- Child and Youth Mental Health Collaborative at the Centre for Addiction and Mental Health and The Hospital for Sick Children, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - William Mandy
- Research Department of Clinical, Educational & Health Psychology, University College London, London, UK
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Abstract
Examining sex differences in the brain has been historically contentious but is nonetheless important for advancing mental health for both girls and boys. Unfortunately, females in biomedical research remain underrepresented in most mental health conditions including autism spectrum disorders (ASD), even though equal inclusion of females would improve treatment for girls and yield benefits to boys. This review examines sex differences in the relationship between neuroanatomy and neurogenetics of ASD. Recent findings reveal that girls diagnosed with ASD exhibit more intellectual and behavioral problems compared to their male counterparts, suggesting that girls may be less likely diagnosed in the absence of such problems or that they require a higher mutational load to meet the diagnostic criteria. Thus far, the female biased effect of chromosome 4, 5p15.33, 8p, 9p24.1, 11p12-13, 15q, and Xp22.3 and the male biased effect of 1p31.3, 5q12.3, 7q, 9q33.3, 11q13.4, 13q33.3, 16p11.2, 17q11-21, Xp22.33/Yp11.31, DRD1, NLGN3, MAOA, and SHANK1 deletion have been discovered in ASD. The SNPs of genes such as RYR2, UPP2, and the androgen receptor gene have been shown to have sex-biasing factors in both girls and boys diagnosed with ASD. These sex-related genetic factors may drive sex differences in the neuroanatomy of these girls and boys, including abnormal enlargement in temporal gray and white matter volumes, and atypical reduction in cerebellar gray matter volumes and corpus callosum fibers projecting to the anterior frontal cortex in ASD girls relative to boys. Such factors may also be responsible for the attenuation of brain sexual differentiation in adult men and women with ASD; however, much remains to be uncovered or replicated. Future research should leverage further the association between neuroanatomy and genetics in girls for an integrated and interdisciplinary understanding of ASD.
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Björnsdotter M, Davidovic M, Karjalainen L, Starck G, Olausson H, Wentz E. Grey matter correlates of autistic traits in women with anorexia nervosa. J Psychiatry Neurosci 2017; 43:1-8. [PMID: 29214796 PMCID: PMC5837888 DOI: 10.1503/jpn.170072] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 06/27/2017] [Accepted: 07/11/2017] [Indexed: 12/27/2022] Open
Abstract
Background Patients with anorexia nervosa exhibit higher levels of behaviours typically associated with autism-spectrum disorder (ASD), but the neural basis is unclear. We sought to determine whether elevated autistic traits in women with anorexia nervosa may be reflected in cortical morphology. Methods We used voxel-based morphometry (VBM) to examine regional grey matter volumes in high-resolution MRI structural brain scans in women with anorexia nervosa and matched healthy controls. The Autism-spectrum Quotient (AQ) scale was used to assess autistic traits. Results Women with anorexia nervosa (n = 25) had higher AQ scores and lower bilateral superior temporal sulcus (STS) grey matter volumes than the control group (n = 25). The AQ scores correlated negatively with average left STS grey matter volume in women with anorexia nervosa. Limitations We did not control for cognitive ability and examined only women with ongoing anorexia nervosa. Conclusion Elevated autistic traits in women with anorexia nervosa are associated with morphometric alterations of brain areas linked to social cognition. This finding provides neurobiological support for the behavioural link between anorexia nervosa and ASD and emphasizes the importance of recognizing autistic traits in preventing and treating anorexia nervosa.
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Affiliation(s)
- Malin Björnsdotter
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Monika Davidovic
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Louise Karjalainen
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Göran Starck
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Håkan Olausson
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
| | - Elisabet Wentz
- From the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (Björnsdotter); the Centre for Social and Affective Neuroscience, Linköping University, Linköping, Sweden (Björnsdotter, Olausson); the Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Davidovic, Olausson); the Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden (Karjalainen, Wentz); the Department of Radiation Physics at the Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden (Starck); and the Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden (Starck)
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