The broad autism phenotype in parents of individuals with autism: a systematic review of the literature

Examining the relationship between functional connectivity and broader autistic traits in non-autistic children

In the current study, we used functional near-infrared spectroscopy (fNIRS) to examine functional connectivity (FC) in relation to measures of cognitive flexibility and autistic features in non-autistic children. Previous research suggests that disruptions in FC between brain regions may underlie the cognitive and behavioral traits of autism. Moreover, research has identified a broader autistic phenotype (BAP), which refers to a set of behavioral traits that fall along a continuum of behaviors typical for autism but which do not cross a clinically relevant threshold. Thus, by examining FC in relation to the BAP in non-autistic children, we can better understand the spectrum of behaviors related to this condition and their neural basis. Results indicated age-related differences in performance across three measures of cognitive flexibility, as expected given the rapid development of this skill within this time period. Additionally, results showed that across the flexibility tasks, measures of autistic traits were associated with weaker FC along the executive control network, though task performance was not associated with FC. These results suggest that behavioral scores may be less sensitive than neural measures to autistic traits. Further, these results corroborate the use of broader autistic traits and the BAP to better understand disruptions to neural function associated with autism.

Childhood Academic Performance: A Potential Marker of Genetic Liability to Autism

Autism spectrum disorder (ASD), a heritable neurodevelopmental disorder, confers genetic liability that is often expressed among relatives through subclinical, genetically-meaningful traits, or endophenotypes. For instance, relative to controls, parents of individuals with ASD differ in language-related skills, with differences emerging in childhood. To examine ASD-related endophenotypes, this study investigated developmental academic profiles among clinically unaffected siblings of individuals with ASD (n = 29). Lower performance in language-related skills among siblings mirrored previously-reported patterns among parents, which were also associated with greater subclinical ASD-related traits in themselves and their parents, and with greater symptom severity in their sibling with ASD. Findings demonstrated specific phenotypes, derived from standardized academic testing, that may represent childhood indicators of genetic liability to ASD in first-degree relatives.

Brief report: The impact of the broad autism phenotype on parent perception of autism symptoms in their children with and without autism spectrum disorder compared to teachers

BACKGROUND

Evaluation of children with autism spectrum disorder (ASD) includes caregiver-reported rating scales of symptom presentation. The extent to which a broad autism phenotype (BAP) in parents of children with ASD might impact their endorsement of autism symptoms in their children with and without ASD has not been well evaluated.

AIMS

This study analyzed whether varying degrees of parental BAP were associated with reported autism symptoms in offspring with and without ASD.

METHODS AND PROCEDURES

We used the Broad Autism Phenotype Questionnaire as a measure of BAP in parents and parent- and teacher-report on the Social Responsiveness Scale (SRS) to assess autism symptoms in children with ASD and their typically developing (TD) siblings (N = 5714). We assessed the relationship between parental BAP and parent-teacher discordance. We compared teacher reports of autism symptoms in children with varying degrees of BAP exposure.

OUTCOMES AND RESULTS

Mothers with higher levels of BAP over-reported autism symptoms in their children (compared to teachers) than mothers with lower BAP. TD children from parents with greater BAP displayed more autism symptoms than children from households with less BAP.

CONCLUSIONS AND IMPLICATIONS

BAP is associated with parent report of autism symptoms when compared to teacher report. For children with ASD, it is possible that differences in ratings reflect parent perception and not autism symptomatology; whereas, TD children from households with higher levels of BAP exposure showed more phenotypic autism symptom presentation on teacher-completed measures. Researchers and clinicians should consider BAP when interpreting caregiver and teacher reports.

Broad Autism Phenotype Traits in Parents of Children with Language Impairments: A Comparative Study

INTRODUCTION

The broad autism phenotype (BAP) comprises milder language and cognitive deficits seen in the nonautistic relatives of individuals with autism. BAP represents the range of individuals with a higher number of these characteristics than average but a lower number than would point to a diagnosis of autism. The Broad Autism Phenotype Questionnaire (BAPQ) is one of the efficient and reliable tools to explore and measure BAP traits, namely, aloofness, pragmatic language, and rigid personality, which represent a few of the diagnostic features of autism. Against the background of positive familial history and common causes across the developmental disorders, this study aimed to compare BAP traits in the parents of children with autism spectrum disorder (ASD), specific language impairment (SLI), and social communication disorder (SCD) by means of the BAPQ.

METHODS

A total of 120 parents (60 mothers and 60 fathers) of children with ASD, SCD, and SLI participated in the study. All mothers filled in the self-report version and fathers filled in the informant version of BAPQ simultaneously in the communication intervention setting.

RESULTS

Obtained data was analyzed with the t test and ANOVA to compare self-ratings, informant ratings, and BAPQ scores across groups. The results of the study revealed no statistically significant difference for the overall BAPQ scores (except on the Pragmatic Language subscale). Furthermore, mothers in all 3 groups presented with BAP traits, with pragmatic language deficits being common. These observations point towards an overlap of BAP traits in the mothers of children with language disorders.

CONCLUSION

These findings indicate the value of a detailed assessment of BAP in parents of children with developmental disorders.

The Actor-Partner Effects of Parenting Stress on Quality of Life Among Parents of Children with ASD: The Mediating Role of Mental Quality of Life

The present study investigated the actor-partner effects of parenting stress (PS) on quality of life (QoL) among parents (96 couples) of children with autism spectrum disorder (ASD). Data were collected using the QoL Scale and the PS Index. Structural equation modeling was also utilized to test the hypothesis. The results revealed the effects of PS in each parent on mental QoL of that parent. Maternal PS further shaped physical QoL in mothers. However, PS in one parent did not influence QoL of his or her partner. Accordingly, mental QoL had a mediating role between PS and physical QoL. It was ultimately suggested to take account of QoL among parents in addition to the treatment of children with ASD.

Depressive symptoms of autism spectrum disorder children's siblings in Greece: Associations with parental anxiety and social support

LAY ABSTRACT

Typically developing siblings of children with autism spectrum disorders are often found to exhibit elevated levels of stress and depressive symptoms compared to siblings of typically developing children or siblings of children with other disabilities. Besides the behavioral problems of the child with autism and certain demographic characteristics that have been recognized as factors associated with typically developing siblings' psychological distress, the role of parental mental health and the social support from the family has not been studied sufficiently. The goal of this study is to assess depressive symptoms in 85 Greek school-aged typically developing siblings of children with autism and to investigate for any associations between siblings' depressive symptoms on one hand and demographics, parental mental health, and perceived social support on the other hand. It was found that typically developing siblings had higher levels of depressive symptoms compared to children from a general population sample. In addition, parental anxiety and social support from the family as perceived by the parents themselves were identified as independently associated with typically developing siblings' depressive symptoms. Of note, perceived social support failed to attenuate the association between parental anxiety and siblings' depressive symptoms. These results highlight the importance of assessing both parental and typically developing siblings' psychological state to implement interventions addressed to the needs of all family members.

Attentional bias to fearful faces in infants at high risk for autism spectrum disorder

Individuals with autism spectrum disorder (ASD) and their first-degree relatives show differences from neurotypical individuals in emotional face processing. Prospective studies of infant siblings of children with ASD, a group at high risk for autism (HRA), allow researchers to examine the early emergence of these differences. This study used eye tracking to examine disengagement of attention from emotional faces (fearful, happy, neutral) at 6, 9, and 12 months in low-risk control infants (LRC) and HRA infants who received a subsequent clinical judgment of ASD (HRA+) or non-ASD (HRA-). Infants saw centrally presented faces followed by a peripheral distractor (with face remaining present). For each emotion, latency to shift to the distractor and percentage of trials with no shift were calculated. Results showed increased saccadic latency and a greater percentage of no-shift trials for fearful faces. No between-group differences were present for emotion; however, there was an interaction between age and group for disengagement latency, with HRA+ infants slower to shift at 12 months compared with the other 2 groups. Exploratory correlational analyses looking at shift biases to fearful faces alongside measures of social behavior at 12 and 18 months (from the Communication and Symbolic Behavior Scales) revealed that for HRA+ infants, 9- and 12-month fear biases were significantly related to 12- and 18-month social abilities, respectively. This work suggests that both low- and high-risk infants show biases to threat-relevant faces, and that for HRA+, differences in attention shifting emerge with age, and a stronger fear bias could potentially relate to less social difficulty. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Brain connectivity analysis in fathers of children with autism

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder in which changes in brain connectivity, associated with autistic-like traits in some individuals. First-degree relatives of children with autism may show mild deficits in social interaction. The present study investigates electroencephalography (EEG) brain connectivity patterns of the fathers who have children with autism while performing facial emotion labeling task. Fifteen biological fathers of children with the diagnosis of autism (Test Group) and fifteen fathers of neurotypical children with no personal or family history of autism (Control Group) participated in this study. Facial emotion labeling task was evaluated using a set of photos consisting of six categories (mild and extreme: anger, happiness, and sadness). Group Independent Component Analysis method was applied to EEG data to extract neural sources. Dynamic causal connectivity of neural sources signals was estimated using the multivariate autoregressive model and quantified by using the Granger causality-based methods. Statistical analysis showed significant differences (p value < 0.01) in the connectivity of neural sources in recognition of some emotions in two groups, which the most differences observed in the mild anger and mild sadness emotions. Short-range connectivity appeared in Test Group and conversely, long-range and interhemispheric connections are observed in Control Group. Finally, it can be concluded that the Test Group showed abnormal activity and connectivity in the brain network for the processing of emotional faces compared to the Control Group. We conclude that neural source connectivity analysis in fathers may be considered as a potential and promising biomarker of ASD.

Theory of Mind Performance in Broad Autism Phenotype Groups: Between-Group Differences and Predictor Variables

Investigated between-group differences in cognitive/affective theory of mind (ToM) and predictors of cognitive ToM both within broad autism phenotype/non (BAP/Non-BAP) groups as well as across the sample. The BAP group (n = 45) performed worse than the Non-BAP group (n = 102) on the unexpected outcomes test (UOT), but groups were similar regarding reading the mind in the eyes test (RMET). Stepwise regression indicated RMET best predicted UOT for the BAP group; block design best predicted UOT in the Non-BAP group. BAP traits did not mediate the relation of RMET to UOT performance. While RMET and UOT appear similarly related in BAP/Non-BAP samples, use of emotion recognition abilities in a cognitive ToM task may reflect over-reliance on this skill in the BAP.

The hindi adaptation and standardization of BAPQ: A brief tool for assessing Broad Autism Phenotype

Broad Autism Phenotype (BAP) refers to the characteristics and behaviour patterns similar to the defining features of Autism Spectrum Disorder (ASD) which are sub-threshold but still qualitatively similar to ASD. Broad Autism Phenotype Questionnaire (BAPQ) has been established to be reliable tool for assessing BAP which has been translated in different languages. In this article, we describe adaptation and standardization of BAPQ in Hindi, a widely spoken language in India. The questionnaire was translated into Hindi adhering to the International Test Commission Guidelines. The reliability coefficient obtained using Cronabch's Alphas was moderate (0.608). The self report translated version was then administered to 96 parents of children diagnosed with ASD. 68 participants scored over the cutoff to indicate presence of BAP in them. Their responses on BAPQ were analysed through confirmatory factor analysis. Factor analysis revealed different factor structure than given in the original scale. Therefore, based on the findings, a brief scale of BAP is proposed.

Intact verbal fluency abilities in the Broad Autism Phenotype

This study attempted to replicate the findings of Camodeca and Voelker (2016), who demonstrated that controlled processing weaknesses were evident in the Broad Autism Phenotype (BAP), and that these weaknesses were predictive of real-world pragmatic language problems. One hundred eighty-two undergraduates completed the Delis-Kaplan Executive Function System Verbal Fluency (D-KEFS-VF) test and the Broad Autism Phenotype Questionnaire (BAPQ). Results were partially replicated. Contrary to the previous study, the BAP group (n = 31) did not demonstrate comparative weaknesses in controlled processing, nor were controlled processing abilities predictive of BAPQ Pragmatic Language score. Similar to the previous study, controlled processing did not predict pragmatic language abilities for Non-BAP (n = 151) subjects. For each group, letter fluency score predicted 2nd 15″ interval score (controlled processing abilities); automatic processing (1st 15″ interval) did not. Results suggest that verbal fluency skills in the BAP are similar to controls, and that controlled processing does not account for significant variance in real-world social language in the BAP.

The Association of the Broader Autism Phenotype with Emotion-Related Behaviors in Mothers of Children With and Without Autism Spectrum Traits

Broader autism phenotype (BAP) characteristics (pragmatic language deficits, aloofness, and rigidity) are prevalent in families of individuals with autism spectrum disorder (ASD) and may influence emotion-related behaviors. The current study analyzed associations among BAP characteristics with emotion-related behaviors in mothers of children with and without ASD. Twenty-seven mothers completed BAP and emotion regulation (ER) questionnaires. Maternal affect was coded during an interaction task. BAP rigidity negatively correlated with the ER strategy reappraisal. BAP total and pragmatic scores positively correlated with observed negative affect. Associations remained significant in step-wise regressions that controlled for other BAPQ subscale scores. Findings suggest that pragmatic difficulties may interfere with positive mother-child interactions and mothers with high rigidity may benefit from learning adaptive ER strategies.

Broader autism phenotype in parents of children with autism: a systematic review of percentage estimates

The broader autism phenotype (BAP) is a collection of sub-diagnostic autistic traits more common in families of individuals with autism spectrum disorder (ASD) than in the general population. BAP is a latent construct that can be defined using different domains, measured using multiple instruments, and reported using different techniques. Therefore, estimates of BAP may vary greatly across studies. Our objective was to systematically review studies that reported occurrence of BAP in parents of children with ASD in order to quantify and describe heterogeneity in estimates. We systematically searched PubMed and Scopus using PRISMA guidelines for studies quantifying percentage of parents of children with ASD who had BAP We identified 41 studies that measured BAP in parents of children with ASD. These studies used eight different instruments, four different forms of data collection, and had a wide range of sample sizes (N=4 to N=3299). Percentage with BAP ranged from 2.6% to 80%. BAP was more prevalent in fathers than mothers. Parental BAP may be an important tool for parsing heterogeneity in ASD etiology and for developing parent-mediated ASD interventions. However, the variety in measurement instruments and variability in study samples limits our ability to synthesize estimates. To improve measurement of BAP and increase consistency across studies, universal methods should be accepted and adopted across studies. A more consistent approach to BAP measurement may enable efficient etiologic research that can be meta-analyzed and may allow for a larger evidence base that can be used to account for BAP when developing parent-mediated interventions.

The Role of the Broader Autism Phenotype and Environmental Stressors in the Adjustment of Siblings of Children with Autism Spectrum Disorders in Taiwan and the United Kingdom

The influence of the broader autism phenotype (BAP) on the adjustment of siblings of children with autism has previously been researched mainly in Western cultures. The present research evaluated a diathesis-stress model of sibling adjustment using a questionnaire study including 80 and 75 mother-typically developing sibling dyads in Taiwan and the United Kingdom (UK). UK siblings reported elevated adjustment difficulties compared to the Taiwanese sample and to normative data. Whilst higher BAP levels were generally associated with greater adjustment difficulties, differences were found across cultures and respondents. Although significant diathesis-stress interactions were found, these were in the opposite direction from those predicted by the model, and differed across cultural settings. Implications for culturally-sensitive sibling support are considered.

Investigating the Evidence of Behavioral, Cognitive, and Psychiatric Endophenotypes in Autism: A Systematic Review

Substantial evidence indicates that parents of autistic individuals often display milder forms of autistic traits referred to as the broader autism phenotype (BAP). To determine if discrete endophenotypes of autism can be identified, we reviewed the literature to assess the evidence of behavioral, cognitive, and psychiatric profiles of the BAP. A systematic review was conducted using EMBASE, MEDLINE, PsycINFO, PsycEXTRA, and Global Health. Sixty papers met our inclusion criteria and results are discussed according to the proportion of studies that yield significant deficits per domain. The behavioral, cognitive, and psychiatric endophenotypes in parents of autistic probands are still not clarified; however, evidence suggests mild social/communication deficits, rigid/aloof personality traits, and pragmatic language difficulties as the most useful sociobehavioral candidate endophenotype traits. The existence of deficits in the cognitive domain does suggest familial vulnerability for autism. Furthermore, increased depressed mood and anxiety can also be useful markers; however, findings should be interpreted with caution because of the small number of studies in such heterogeneously broad domains and several methodological limitations.

ASD Validity

ASD research is at an important crossroads. The ASD diagnosis is important for assigning a child to early behavioral intervention and explaining a child’s condition. But ASD research has not provided a diagnosis-specific medical treatment, or a consistent early predictor, or a unified life course. If the ASD diagnosis also lacks biological and construct validity, a shift away from studying ASD-defined samples would be warranted. Consequently, this paper reviews recent findings for the neurobiological validity of ASD, the construct validity of ASD diagnostic criteria, and the construct validity of ASD spectrum features. The findings reviewed indicate that the ASD diagnosis lacks biological and construct validity. The paper concludes with proposals for research going forward.

Automatic and controlled processing and the Broad Autism Phenotype

Research related to verbal fluency in the Broad Autism Phenotype (BAP) is limited and dated, but generally suggests intact abilities in the context of weaknesses in other areas of executive function (Hughes et al., 1999; Wong et al., 2006; Delorme et al., 2007). Controlled processing, the generation of search strategies after initial, automated responses are exhausted (Spat, 2013), has yet to be investigated in the BAP, and may be evidenced in verbal fluency tasks. One hundred twenty-nine participants completed the Delis-Kaplan Executive Function System Verbal Fluency test (D-KEFS; Delis et al., 2001) and the Broad Autism Phenotype Questionnaire (BAPQ; Hurley et al., 2007). The BAP group (n=53) produced significantly fewer total words during the 2nd 15" interval compared to the Non-BAP (n=76) group. Partial correlations indicated similar relations between verbal fluency variables for each group. Regression analyses predicting 2nd 15" interval scores suggested differentiation between controlled and automatic processing skills in both groups. Results suggest adequate automatic processing, but slowed development of controlled processing strategies in the BAP, and provide evidence for similar underlying cognitive constructs for both groups. Controlled processing was predictive of Block Design score for Non-BAP participants, and was predictive of Pragmatic Language score on the BAPQ for BAP participants. These results are similar to past research related to strengths and weaknesses in the BAP, respectively, and suggest that controlled processing strategy use may be required in instances of weak lower-level skills.

An Autistic Endophenotype and Testosterone Are Involved in an Atypical Decline in Selective Attention and Visuospatial Processing in Middle-Aged Women

Mothers of offspring with autism spectrum disorders (ASD) could present mild forms of their children's cognitive characteristics, resulting from prenatal brain exposure and sensitivity to testosterone (T). Indeed, their cognition is frequently characterized by hyper-systemizing, outperforming in tests that assess cognitive domains such as selective attention, and fine motor and visuospatial skills. In the general population, all these start to decline around the mid-forties. This study aimed to characterize whether middle-aged women who are biological mothers of individuals with ASD had better performance in the aforementioned cognitive skills than mothers of normative children (in both groups n = 22; mean age = 45), using the standardized Stroop and mirror-drawing tests. We also examined the role of T in their performance in the aforementioned tests. ASD mothers outperformed controls in both tests, giving more correct answers and making fewer mistakes. In addition, they presented higher T levels, which have been associated with better cognitive performance. Cognitive decline in specific skills with aging could be delayed in these middle-aged women, corresponding to a cognitive endophenotype, T playing an important role in this process.

Language abilities in preschool-aged siblings of children with autism spectrum disorders – preliminary report

<b>Background</b><br /> The characteristics of autism spectrum disorders (ASD) observed among relatives of people affected with autism are referred to as broader autism phenotype (BAP). Among the components of BAP are language and communication skills. Research to date on these skills amongst the relatives of individuals with ASD is inconclusive. Furthermore, limited data are available about preschool-aged siblings of children with ASD.<br /> <br /> <b>Participants and procedure</b><br /> Eighty-six children aged 4 years and 6 months – 6 years and 11 months took part in the study (32 girls and 54 boys). They were divided into four groups: siblings of children with autism (S/ASD), high-functioning children diagnosed with autism spectrum disorders (HF/ASD), siblings of children with Down syndrome (S/DS) and siblings of typically developing children (Controls, C). Communication and language skills were tested using the Vocabulary Test for Children (TSD). It was used to assess two kinds of verbal skills: receptive language (passive) and expressive language (active).<br /> <br /> <b>Results</b><br /> No differences were observed in expressive lanquage or receptive language between siblings of children with ASD and siblings of children with DS as well as typically developing children. In terms of receptive language and general communication skills, siblings of children with ASD scored higher than high functioning children with ASD. High functioning children with ASD displayed difficulties with receptive language, expressive language, general language and communication skills.<br /> <br /> <b>Conclusions</b><br /> The results suggest that siblings of children with ASD do not display deficits in communication and language skills. It is however important to note that due to a small sample size this study should be considered as preliminary.