Perceived misdiagnosis of psychiatric conditions in autistic adults

Background

Many autistic people, particularly women, do not receive an autism diagnosis until adulthood, delaying their access to timely support and clinical care. One possible explanation is that autistic traits may initially be misinterpreted as symptoms of other psychiatric conditions, leading some individuals to experience misdiagnosis of other psychiatric conditions prior to their autism diagnosis. However, little is currently known about the frequency and nature of psychiatric misdiagnoses in autistic adults.

Methods

Using data collected in the first half of 2019 from an ongoing longitudinal register of autistic adults in the Netherlands, this study explored the frequency of perceived psychiatric misdiagnoses before receiving an autism diagnosis. Gender differences were also explored. A sample of 1211 autistic adults (52.6% women, mean age 42.3 years), the majority of whom were Dutch and relatively highly educated, was evaluated.

Findings

Results showed that 24.6% (n = 298) of participants reported at least one previous psychiatric diagnosis that was perceived as a misdiagnosis. Personality disorders were the most frequent perceived misdiagnoses, followed by anxiety disorders, mood disorders, chronic fatigue syndrome/burnout-related disorders, and attention-deficit/hyperactivity disorder. Autistic women (31.7%) reported perceived misdiagnoses more frequently than men (16.7%). Women were specifically more likely than men to report perceived misdiagnoses of personality disorders, anxiety disorders, and mood disorders. Women also reported prior psychiatric diagnoses more often in general (65.8% versus 34.2% in men). Within the group of individuals with a prior diagnosis, perceived misdiagnoses were equally likely for men and women.

Interpretation

One in four autistic adults, and one in three autistic women, reported at least one psychiatric diagnosis, obtained prior to being diagnosed with autism, that was perceived as a misdiagnosis. Inaccurate diagnoses are linked to long diagnostic pathways and delayed recognition of autism. These findings highlight the need for improved training of mental health practitioners, in order to improve their awareness of the presentation of autism in adulthood and of the complex relationship between autism and co-occurring conditions. The current study constitutes a first step towards showing that autistic adults, and particularly women, may be at greater risk of experiencing misdiagnoses. Future studies based on larger, more representative samples are required, to replicate current findings and provide more reliable estimates of the overall frequency of misdiagnoses as well as the frequency of misdiagnoses for specific psychiatric conditions.

Funding

This study was made possible by funding from the Netherlands Organisation for Health Research and Development (ZonMW), project number 60-63600-98-834.

Unpacking the overlap between Autism and ADHD in adults: A multi-method approach

The overlap between Autism and Attention-Deficit Hyperactivity Disorder (ADHD) is widely observed in clinical settings, with growing interest in their co-occurrence in neurodiversity research. Until relatively recently, however, concurrent diagnoses of Autism and ADHD were not possible. This has limited the scope for large-scale research on their cross-condition associations, further stymied by a dearth of open science practices in the neurodiversity field. Additionally, almost all previous research linking Autism and ADHD has focused on children and adolescents, despite them being lifelong conditions. Tackling these limitations in previous research, 5504 adults - including a nationally representative sample of the UK (Study 1; n = 504) and a large pre-registered study (Study 2; n = 5000) - completed well-established self-report measures of Autism and ADHD traits. A series of network analyses unpacked the associations between Autism and ADHD at the individual trait level. Low inter-item connectivity was consistently found between conditions, supporting the distinction between Autism and ADHD as separable constructs. Subjective social enjoyment and hyperactivity-impulsivity traits were most condition-specific to Autism and ADHD, respectively. Traits related to attention control showed the greatest Bridge Expected Influence across conditions, revealing a potential transdiagnostic process underlying the overlap between Autism and ADHD. To investigate this further at the cognitive level, participants completed a large, well-powered, and pre-registered study measuring the relative contributions of Autism and ADHD traits to attention control (Study 3; n = 500). We detected age- and sex-related effects, however, attention control did not account for the covariance between Autism and ADHD traits. We situate our findings and discuss future directions in the cognitive science of Autism, ADHD, and neurodiversity, noting how our open datasets may be used in future research.

Exploring autistic adults' psychosocial experiences affecting beginnings, continuity and change in camouflaging over time: A qualitative study in Singapore

LAY ABSTRACT

Over their lifetimes, many autistic people learn to camouflage (hide or mask) their autism-related differences to forge relationships, find work and live independently in largely non-autistic societies. Autistic adults have described camouflaging as a 'lifetime of conditioning . . . to act normal' involving 'years of effort', suggesting that camouflaging develops over an autistic person's lifetime and may start early on, in childhood or adolescence. Yet, we know very little about why and how autistic people start to camouflage, or why and how their camouflaging behaviours continue or change over time. We interviewed 11 Singaporean autistic adults (9 male, 2 female, 22-45 years old) who shared their camouflaging experiences. We found that autistic adults' earliest motivations to camouflage were largely related to the desire to fit in and connect with others. They also camouflaged to avoid difficult social experiences (such as being teased or bullied). Autistic adults shared that their camouflaging behaviours became more complex and that, for some, camouflaging became a part of their self-identity over time. Our findings suggest that society should not pathologise autistic differences, but instead accept and include autistic people, to reduce the pressure on autistic people to hide who they truly are.

Re-examining the association between the age of learning one is autistic and adult outcomes

LAY ABSTRACT

An interesting recent study found that people who learned they were autistic at a younger age felt more positive about their lives (i.e., had better quality of life) than those who learned at an older age. However, this study has some limitations: (a) the study only involved a fairly small group of university students, (b) whether 'learning one is autistic' referred to learning about one's diagnosis or receiving one's diagnosis was unclear, (c) the influence of other factors on the link between age of learning one is autistic and quality of life was not considered, and (d) the assessment of different areas of quality of life was limited. Addressing these limitations, we re-examined whether the age at which one learns they are autistic relates to quality of life in adulthood. Contrary to the previous study, we found the age at which one learns about their autism does not have a significantly independent impact on their quality of life as an adult. Rather, other factors (e.g., autistic traits, sex, and additional mental health conditions) may have a greater impact. Given our participant sample was larger and more diverse in age and education level compared to previous research, this finding is likely to be more applicable to autistic adults from different backgrounds. Importantly, however, we are not suggesting that individuals should be made aware of their diagnosis later than sooner. Getting a timely diagnosis remains crucial for autistic people and their families to access appropriate support.

Attention-deficit hyperactivity disorder traits are a more important predictor of internalising problems than autistic traits

Autism Spectrum Disorder (ASD) and Attention-Deficit Hyperactivity Disorder (ADHD) are both linked to internalising problems like anxiety and depression. ASD and ADHD also often co-occur, making their individual statistical contributions to internalising disorders difficult to investigate. To address this issue, we explored the unique associations of self-reported ASD traits and ADHD traits with internalising problems using a large general population sample of adults from the United Kingdom (N = 504, 49% male). Classical regression analyses indicated that both ASD traits and ADHD traits were uniquely associated with internalising problems. Dominance and Bayesian analyses confirmed that ADHD traits were a stronger, more important predictor of internalising problems. However, brief depression and anxiety measures may not provide a comprehensive index of internalising problems. Additionally, we focused on recruiting a sample that was representative of the UK population according to age and sex, but not ethnicity, a variable that may be linked to internalising disorders. Nevertheless, our findings indicate that while ASD and ADHD uniquely predict internalising problems, ADHD traits are a more important statistical predictor than ASD traits. We discuss potential mechanisms underlying this pattern of results and the implications for research and clinical practice concerning neurodevelopmental conditions.

Psychological strengths and well-being: Strengths use predicts quality of life, well-being and mental health in autism

LAY ABSTRACT

It is often suggested that supporting autistic people to identify and use their strengths will lead to positive outcomes. However, little research has explored if this is true. To date, no research has explored whether autistic people already have knowledge of and use their strengths, nor whether increased strengths knowledge and use is linked to good outcomes, such as a better quality of life, well-being and improved mental health. Comparing large samples of autistic and non-autistic people, this study tested these unanswered questions. We found that autistic and non-autistic people reported similar strengths, but autistic people reported less knowledge and use of their strengths compared to non-autistic people. Importantly however, autistic people who reported using their strengths often had better quality of life, well-being and mental health than autistic people who reported using their strengths less frequently. We, therefore, propose that supporting autistic people to use their strengths more often may be a valuable way to boost well-being in this population.

Practitioner Review: Attention-deficit hyperactivity disorder and autism spectrum disorder - the importance of depression

Young people with neurodevelopmental disorders, such as attention-deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD), show high rates of mental health problems, of which depression is one of the most common. Given that depression in ASD and ADHD is linked with a range of poor outcomes, knowledge of how clinicians should assess, identify and treat depression in the context of these neurodevelopmental disorders is much needed. Here, we give an overview of the latest research on depression in young people with ADHD and ASD, including possible mechanisms underlying the link between ADHD/ASD and depression, as well as the presentation, assessment and treatment of depression in these neurodevelopmental disorders. We discuss the implications for clinicians and make recommendations for critical future research in this area.

"Late-onset" ADHD symptoms in young adulthood: Is this ADHD?

Objective: We investigated whether "late-onset" ADHD that emerges in adolescence/adulthood is similar in risk factor profile to: (1) child-onset ADHD, but emerges later because of scaffolding/compensation from childhood resources; and (2) depression, because it typically onsets in adolescence/adulthood and shows symptom and genetic overlaps with ADHD. Methods: We examined associations between late-onset ADHD and ADHD risk factors, cognitive tasks, childhood resources and depression risk factors in a population-based cohort followed-up to age 25 years (N=4224-9764). Results: Parent-rated late-onset ADHD was like child-onset persistent ADHD in associations with ADHD polygenic risk scores and cognitive task performance, although self-rated late-onset ADHD was not. Late-onset ADHD was associated with higher levels of childhood resources than child-onset ADHD and did not show strong evidence of association with depression risk factors. Conclusions: Late-onset ADHD shares characteristics with child-onset ADHD when parent-rated, but differences for self-reports require investigation. Childhood resources may delay the onset of ADHD.

Rethinking fast and slow processing in autism

Following the popularity of dual process models in social and cognitive psychology, there is major interest in the possibility that autism is associated with impaired "fast" intuitive thinking but enhanced "slow" or "rational" deliberative thinking. If correct, this has great potential to help understand various strengths and difficulties characteristic of autism. Previous empirical investigations of this phenomenon, however, are marred by concerns about the measurement of intuitive and deliberative processing, as well as broader problems in clinical psychological science (e.g., small underpowered studies, lack of replication). Making a step change, we conducted four large-scale studies to examine dual processing in autism, including a preregistered comparison of 200 autistic and nonautistic adults. Participants completed contemporary cognitive and self-report measures of intuitive and deliberative processing, as well as a psychometrically robust measure of general cognitive ability. Except for lower self-reported intuitive thinking, we found no unique contributions of autism to intuitive or deliberative thinking across all four studies, as evidenced by frequentist and Bayesian analyses. Overall, these studies indicate that intuitive and deliberative thinking is neither enhanced nor particularly impaired in relation to autism. We deliberate on the implications of these findings for theories of autism and future investigation of strengths and difficulties in autistic people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Anthropomorphic tendencies in autism: A conceptual replication and extension of White and Remington (2019) and preliminary development of a novel anthropomorphism measure

LAY ABSTRACT

Anthropomorphism is the tendency to attribute human-like qualities (e.g. thoughts and feelings) to non-human entities (e.g. objects and weather systems). Research by White and Remington (2019) suggested that anthropomorphism is more common in autistic compared to neurotypical adults, which is interesting given that autistic individuals sometimes misunderstand the thoughts and feelings of other people. In this article, we re-examined the link between autism and anthropomorphism in a large sample of adults with varying degrees of autistic traits, with several important methodological advances on previous research. Across two studies, we found that individuals with more autistic traits reported greater anthropomorphic tendencies. As part of these analyses, we had to develop a new, refined measure of anthropomorphism, which showed better reliability and validity than the original measure. This measure will be useful in future autism-related research. Overall, advancing White and Remington's study, these findings help us to better understand individual differences in socially relevant processes, including those that may be enhanced in autism (e.g. anthropomorphism).

Variable Emergence of Autism Spectrum Disorder Symptoms From Childhood to Early Adulthood

OBJECTIVE

Autism spectrum disorder (ASD) is currently considered an early-onset neurodevelopmental condition. Follow-up studies of clinic-ascertained autism suggest that autistic symptoms typically decline with age, although symptom improvement is limited for some. To date there have been no population-based prospective studies investigating the natural history of autistic symptoms from childhood to adulthood. The aim of this study was to characterize the development and heterogeneity of autistic symptoms in a population-based cohort from childhood to age 25.

METHODS

Data were analyzed in a prospective U.K. population-based cohort (ALSPAC). Trajectories were derived using five assessments of the parent-rated Social and Communication Disorders Checklist (SCDC) spanning ages 7-25. Additional measures were used to validate symptom trajectories.

RESULTS

Three distinct SCDC symptom trajectory classes were identified: low (88.5%), declining (5.0%), and late-emerging (6.5%). Both the declining and late-emerging trajectory classes were associated with child and adult ASD measures, low IQ, communication problems, peer problems, and worse adult functioning compared with the low trajectory class. Male sex was associated with a higher likelihood of being in the declining trajectory class (odds ratio=2.84, 95% CI=2.19, 3.69). This sex difference was not observed in the late-emerging class (odds ratio=1.00, 95% CI=0.80, 1.24) compared with the low trajectory class.

CONCLUSIONS

ASD symptom levels that emerged early tended to decline across development, although impairment was still present in adulthood for some. For others, autistic symptoms emerged across adolescence and adulthood. This challenges our current understanding that ASD symptoms inevitably first manifest early in development.

Further developing the Frith-Happé animations: A quicker, more objective, and web-based test of theory of mind for autistic and neurotypical adults

The Frith-Happé Animations Test, depicting interactions between triangles, is widely used to measure theory of mind (ToM) ability in autism spectrum disorder (ASD). This test began with recording, transcribing, and subjectively scoring participants' verbal descriptions, which consistently found ToM-specific difficulties in ASD. More recently in 2011, White et al. created a more objective version of this ToM test using multiple-choice questions. However, there has been surprisingly little uptake of this test, hence it is currently unclear if White et al.'s findings replicate. Further, the lack of an online version of the test may be hampering its use in large-scale studies and outside of research settings. Addressing these issues, we report the development of a web-based version of the Frith-Happé Animations Test for autistic and neurotypical adults. An online version of the test was developed in a large general population sample (study 1; N = 285) and online data were compared with those collected in a lab-based setting (study 2; N = 339). The new online test was then administered to adults with a clinical diagnosis of ASD and matched neurotypical controls (study 3; N = 231). Results demonstrated that the test could successfully be administered online to autistic adults, who showed ToM difficulties compared to neurotypical adults, replicating White et al.'s findings. Overall, we have developed a quicker, more objective, and web-based version of the Frith-Happé Animations Test that will be useful for social cognition research within and beyond the field of autism, with potential utility for clinical settings. LAY SUMMARY: Many autistic people find it hard to understand what other people are thinking. There are many tests for this 'mentalising' ability, but they often take a long time to complete and cannot be used outside of research settings. In 2011, scientists used short silent animations of moving shapes to create a fast way to measure mentalising ability. We developed this into an online test to use in research and clinics to measure mentalising ability in autism.

Development and validation of the Four-Item Mentalising Index

Mentalising, also known as "Theory of Mind", is the ability to understand and infer the cognitions of others, such as their perceptions, intentions, and beliefs. Although several tools have been designed to measure mentalising in adults, there exist methodological and practical limitations. Many of the existing measures conflate mentalising with similar constructs (e.g., empathy), and most are lengthy measures that are unsuitable for large population-based studies and clinical practice. These issues are currently hampering clinical and non-clinical investigations into mentalising and related social-cognitive abilities. Drawing on questionnaire measures of social cognition, we conceived a self-report mentalising scale, the Four-Item Mentalising Index (FIMI; Studies 1a and b). The FIMI was developed through a series of studies examining its factor structure and reliability (Studies 2a and b) and by testing its construct validity against a cognitive mentalising task, autistic traits, and comparing scores in autistic and non-autistic people (Studies 3a and b). Together, we demonstrate that the FIMI is a conceptually and methodologically robust tool for measuring mentalising ability in the general population, including autistic and non-autistic people. Future research directions and practical (clinical) applications of the scale are discussed, with a focus on improving understanding and management of (a)typical mentalising ability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Autonomic dysfunction in autism: The roles of anxiety, depression, and stress

Autism spectrum disorder (ASD) is associated with atypical autonomic nervous system (ANS) function. However, little is known about this relationship, while accounting for co-occurring mental health conditions (e.g. anxiety) that are also associated with ANS dysfunction. In addition, research on the ANS has typically involved physiological measurements, without using more clinically meaningful measures of ANS dysfunction, such as the self-reported frequency of ANS-related physical health symptoms. Furthermore, very little is known about ANS function in autistic adults, given that previous research has focused on ANS dysfunction in children with ASD. Addressing these gaps in the literature, we compared ANS function in adults with(out) ASD (Study 1). Although autistic adults reported greater ANS dysfunction than matched neurotypical controls, this difference was not significant after controlling for anxiety and depression. Similarly, in a large nonclinical sample (Study 2), we found that anxiety and stress mediated the relationship between autistic traits and ANS dysfunction. Together, we conclude that ANS dysfunction is not a feature of ASD per se, but instead attributable to the high levels of anxiety and stress in autistic adults. We discuss the clinical relevance of these findings for managing ANS dysfunction and other physical and mental health concerns in autistic adulthood.

Lay abstract

The autonomic nervous system (ANS) is responsible for the functioning of the heart, bladder, pupils and several other bodily functions. Therefore, when the ANS functions abnormally, individuals can experience a number of physical symptoms, including dizziness, abnormal sweating and digestive difficulties. Currently, it is unclear if autistic adults experience ANS dysfunction. Therefore, in this study, we investigated whether autistic adults report more ANS-related physical symptoms, indicating greater ANS dysfunction, and whether this may be related to autism, or rather anxiety, depression, or stress. The findings suggest that ANS dysfunction, where found in autism, is due to co-occurring stress and anxiety. We therefore propose that treating stress and anxiety may be an effective way to ameliorate ANS-related health problems in autistic adults.

Recent crosse designs increase ball velocity: Implications for injury in women's lacrosse

The aim of this preliminary investigation was to describe the kinematics of ball release from 24 different lacrosse stick models during the performance of an overhand pass. Multiple trials (N=120) of an overhand lacrosse pass, performed by an elite female lacrosse athlete, were captured in the sagittal plane using two-dimensional videography and analysed using motion analysis software. On average, there was a tendency for balls to release earlier from wood crosses (180.8+/-16.0 degrees ) than from synthetic crosses (183.6+/-6.0 degrees ) (p>0.15) and earlier from non-planar linear (179.7+/-6.7 degrees ) and non-planar curvilinear (182.5+/-9.5 degrees ) crosse heads than from traditional, planar-headed sticks (185.6+/-11.7 degrees ). Peak angular velocities of the stick shaft were lower for the wood as compared to the synthetic crosses (p<0.001) with mean values of 15.4+/-0.6rads(-1) and 16.6+/-0.7rads(-1), respectively. Similarly, the resultant velocity of the ball at release was significantly lower (p<0.001) for the wood crosses (13.9+/-0.8ms(-1)) as compared to the synthetic crosses (14.8+/-0.6ms(-1)). These results indicate that changes in the material composition and design of lacrosse sticks are changing the timing and rate at which balls release from the crosse pocket. Strict rule enforcement, good coaching, the mandatory use of protective equipment and continuous monitoring of changes in stick technology will be required if the frequency and severity of ocular, head and facial injuries are to be controlled.

Lacrosse stick entrapment injury to the thumb

A case of injury to the left thumb following an errant stick check, and subsequent entrapment of the digit in the open sidewall of a lacrosse stick, is presented. A circumferential laceration, severe swelling, and bruising to the proximal phalanx resulted. This case report emphasises the need to limit the dimensions of openings in the sidewalls of lacrosse sticks to prevent the occurrence of this and other preventable injuries.

The influence of external orthotic support on the adaptive gait characteristics of individuals with chronically unstable ankles

External orthotic supports or braces are used clinically to treat individuals with chronically unstable ankles. Braces have efficacious effects on dynamic strength, passive tissue tension, and proprioception, but their effects on gait remains undetermined. The purpose of this study was to determine if overground locomotion, including walking up a step and a curb are influenced by orthotic device use. Twenty subjects, 10 with no previous injury and 10 with chronically unstable ankles, performed with no brace, a flexible brace and a semi-rigid brace while walking on a level surface, up a step and on a ramp. Differences were noted in kinematic and kinetic gait parameters between groups and between step and ramp conditions, suggesting that gait patterns vary between individuals who have had ankle sprain and those who have not. Few differences were noted between the brace and no brace conditions for both groups. Adding to the previously described efficacious benefits, we conclude that bracing does not alter selected gait parameters in individuals who have chronic ankle instability.

Bilateral Q angle asymmetry and anterior knee pain syndrome

OBJECTIVE

To determine whether quadriceps (Q) angles were bilaterally symmetric in individuals asymptomatic vs symptomatic for anterior knee pain.

DESIGN

Cross-sectional study.

BACKGROUND

Previous attempts to link excessive Q angles to the occurrence of knee pain have yielded equivocal results. Deriving unilateral rather than bilateral measures of the Q angle and thereafter analysing data using traditional between-group analysis-of-variance structural models may, however, play a role in obscuring the true nature of the Q angle-knee pain relationship.

METHODS

Left and right Q angles were goniometrically measured in 75 subjects (37 males, 38 females) while they adopted a static, standing position with quadriceps relaxed. The majority (n = 50) were asymptomatic, while the remainder were unilaterally (n = 11) or bilaterally (n = 14) symptomatic for anterior knee pain. A questionnaire was used to determine the extent and magnitude of pain experienced in each of the symptomatic subjects.

RESULTS

Significant right vs left lower limb differences in Q angles were observed by group (p < 0.001) and group by gender (p < 0.05). Mean values, however, did not always reflect the true variation of data within the sample. Forty-seven percent of the subjects studied demonstrated a minimum 4 degrees bilateral Q angle difference, while in 13 of 75 subjects, this difference ranged from 8 degrees to 12 degrees. Only a weak yet significant relationship between right and left Q angles (r = 0.53, p < 0.001) was noted. While there were no correlations between Q angle measures and the magnitude of discomfort experienced in unilateral knee pain sufferers, these relationships were weak yet significant in bilateral knee pain sufferers.

CONCLUSION

Q angles are not bilaterally symmetric, with the magnitude and direction of the observed asymmetry varying according to whether an individual is asymptomatic, unilaterally symptomatic, or bilaterally symptomatic for anterior knee pain.

RELEVANCE

Future investigations of the Q angle must ensure that measures are derived bilaterally and analysed appropriately. Data from unilateral vs bilateral symptomatic subjects should be evaluated separately, and the shortcomings of standard ANOVA structural models must be recognized.

Bilateral within-subject Q angle asymmetry in young adult females and males

Previous investigations of the quadriceps angle (or Q angle) and its relationship to knee disorders have yielded equivocal results. Methodological differences may account for some of the observed discrepancies, but so too may the tendency for investigators to rely on between-group rather than within-subject research designs. The purpose of this investigation was to study the between-group (male versus female) and within-subject (right versus left lower limb) differences in Q angle measures in subjects with no history of knee disorders. The right and left Q angles of fifty young men and women were measured goniometrically with subjects standing in an erect, weight-bearing position. In males, there was little disparity in the magnitude of the Q angle between the right (9.5 degrees +/- 4.6) and left (10.4 degrees +/- 5.7) lower limb. Similarly, in females, the mean value for the right Q angle (10.5 degrees +/- 4.2) was only slightly smaller in magnitude than that of the left (12.2 degrees +/- 5.2). A 2 x 2 ANOVA revealed no significant gender (p < 0.17) or right to left lower limb (p < 0.19) differences. However, when the data for each subject was examined on an individual basis, the magnitude of the right and left Q angles differed by 4 degrees or more in 24 subjects. In 10 subjects, this difference ranged from 8.0 degrees to 10.3 degrees. For the majority of subjects the left Q angle was greater in magnitude than the right Q angle. These results suggest that (I) the assumption of symmetry in right versus left lower limb Q angle measures may be erroneous, (II) statistical comparisons of mean values may not be the best method by which to analyze Q angle data, and (III) further investigation of bilateral within-subject Q angle asymmetry is warranted.

The quadriceps angle: a review of the literature

Previous investigations of the quadriceps (Q) angle and its relationship to knee disorders have yielded equivocal results. The purpose of this paper is to present a review of the current literature on the Q angle and to examine the differences in Q angles when measured: 1) under differing measurement protocols; 2) between asymptomatic and symptomatic populations; 3) between male and female samples; and 4) from side to side within subjects. Little scientific evidence exists to support the commonly held assumptions that Q angles are larger in symptomatic vs. asymptomatic or that they are equal in the right vs. left lower limb. However, larger mean values are consistently observed in groups of young adult females vs. young adult males.

Segmental inertial parameters of the human trunk as determined from computed tomography

This study used computed tomography (CT) imaging to determine in vivo mass, center of mass (CM), and moments of inertia (Icm) about the CM of discrete segments of the human torso. Four subjects, two males and two females, underwent serial transverse CT scans that were collected at 1-cm intervals for the full length of the trunk. The pixel intensity values of transverse images were correlated to tissue densities, thereby allowing trunk section mass properties to be calculated. The percentage of body mass observed by vertebral levels ranged from 1.1% at T1 to 2.6% at L5. The masses of the upper, middle, and lower trunk segments as percentages of body mass were estimated to be 18.5, 12.2, and 10.7%, respectively. The whole trunk mass was estimated to comprise 41.6% of the total body mass. Transverse vertebral CM values were found to lie anterior to their respective vertebral centroids by up to 5.0 cm in the lower thoracic region. For the upper, middle, and lower trunk segments, the average CM positions were found to be 25.9, 62.5, and 86.9% of the distance from the superior to inferior ends of the trunk. The upper and middle trunk CMs corresponded to approximately 4.0 cm anterior to T7/T8 vertebral centroid levels and 1.0 cm anterior to L3/L4 vertebral centroid levels, respectively. For the whole trunk, the CM was 52.7% of the distance from the xiphoid process and approximately 2.0 cm anterior to L1/L2 vertebral centroid levels. Variations in CM and Icm values were observed between subject, but these were within the range of previous reports of body segment parameters. Differences from previous studies were attributable to variations in boundary definitions, measurement techniques, population groups, and body states (live versus cadaver) examined. The disparity between previous findings and findings of this study emphasizes the need to better define the segmental properties of the trunk so that improved biomechanical representation of the body can be achieved.

Eye injuries in women's lacrosse: strict rule enforcement and mandatory eyewear required

OBJECTIVE

To inform practitioners of the risk of ocular injury in women's lacrosse and to advocate the mandatory use of protective eyewear.

DESIGN, MATERIALS AND METHODS

Athletes reported retrospectively, via a questionnaire, on the nature and circumstances leading to their injuries.

MEASUREMENTS AND MAIN RESULTS

Four case reports of injury to ocular and adjacent nasal structures are presented. None of the athletes was wearing protective equipment at the time that her injuries were incurred.

CONCLUSIONS

Mandatory eye protection should be introduced into the game of women's field lacrosse. Eyewear may have prevented the injuries reported in this article.

Hockey helmets, face masks, and injurious behavior

OBJECTIVE

To educate physicians about factors that contribute to injurious behaviors in ice hockey and to propose that the medical community play a role in advocating change within the sport.

METHODS

A review of relevant literature on the topic was conducted, with information drawn from scientific journal publications, conference proceeding, theses, and newspaper publications.

RESULTS

The introduction of mandatory head and facial protection has been effective in virtually eliminating ocular, facial, and dental injuries in youth hockey, but it has also been problematically linked with an increase in catastrophic spinal injuries. Players adopt a false sense of security when donning the equipment, leading them to take excessive and unwarranted risks because of the protection they are supposedly afforded. The addition of these protective devices has also altered how officials perceive game situations, leading them to be more lenient in administering penalties. The net result has been an increase in illegal and injurious behaviors, such as checking from behind.

CONCLUSION

Physician advocacy may play an important role in effecting change within the sport.

The geometry of the psoas muscle as determined by magnetic resonance imaging

Magnetic resonance images from fifteen physically active and asymptomatic male volunteers were collected to present morphometric parameters on the psoas and its moment arms, which are important in the study of spinal mechanics and models for the investigation of low back pain. The mean age of the subjects was 21.5 +/- 1.8 years. Data were obtained from nine vertebral and/or intervertebral levels (L2, L2/L3, L3, L3/L4, L4, L4/L5, L5, L5/S1, S1). In general, the psoas increased in size as it descended the trunk, moving anteriorly and slightly laterally in relation to the vertebral column. Maximum cross-sectional areas for the psoas (M = 16.3cm2) were observed at the L4/L5 level. Right-left symmetry was apparent in the aforementioned dimension, but not with respect to the mediolateral (X) diameter of the muscle. The length of the X moment arm was significantly (p < .05) greater for the right versus the left psoas from L3 to S1, with the length increasing as the psoas descended the trunk. However, this trend was not noted for the anteroposterior (Y) moment arm where observed values remained relatively small throughout the course of the muscle. These results will contribute to the study of low back pain onset and the design of appropriate rehabilitation interventions by providing accurate morphometric parameters for biomechanical models to predict of the loading conditions of the spine in vivo.

Stairclimbing kinematics on stairs of differing dimensions

The purpose of this study was to provide a kinematic description of the task of stair ascent and descent. Fifteen women were divided into short, medium, and tall subject groups. Three testing staircases of different riser and tread dimensions were used. Temporal and cinematographic data were collected simultaneously via switchmats and a high-speed camera, respectively. Measures of stairclimbing gait cycle duration, swing and stance phase durations, cadence, and velocity appeared to be systematically related to subject height. Stance (19% to 64%) and swing (36% to 81%) phase durations varied considerably depending on stair dimensions during stair descent. Less variation was observed in stance (50% to 60%) and swing (40% to 50%) values during tasks of stair ascent. Individuals appeared to adjust to stair dimensions by varying the flexion/extension patterns of the knee rather than those of the ankle or hip. Depending on the staircase climbed, knee flexion angles ranging from 83 degrees to 105 degrees were required. Stair dimensions, therefore, appeared to influence the temporal and angular kinematics of the lower limb during stairclimbing.