Anxiety in children and adolescents with autism spectrum disorders

Anxiety and poor stress management are common concerns in clinical samples of children with autism spectrum disorders (ASD). Anxiety may worsen during adolescence, as young people face an increasingly complex social milieu and often become more aware of their differences and interpersonal difficulties. This review summarizes the state of research on the prevalence, phenomenology, and treatment of anxiety in youth with autism and related conditions such as Asperger's Disorder. Using search words autism, asperger(s), or pervasive developmental disorder and anxiety or anxious to find reports published between 1990 and 2008, this review identified 40 papers. The results of the review suggest that anxiety, whether measured categorically or dimensionally, is indeed common in children and adolescents with autism spectrum disorders and may be a source of additional morbidity. The assessment of anxiety disorders in ASD should be conducted using multiple informants and modalities, as children with ASD often do not display age-typical symptoms of anxiety. To date, relatively few controlled intervention studies using well-characterized samples have been conducted despite preliminary evidence for efficacy of select pharmacological and psychosocial approaches. Recommendations for future applied research are presented and clinical implications are explored.     

孤独症幼儿对面部情绪表情认知特征的初步研究

目的探究孤独症患儿对面部情绪表情的认知特征。方法选取2007年3月至2008年9月在中山大学附属第三医院发育行为中心诊断为孤独症的18～36个月患儿作为孤独症组,同期行健康查体的年龄、性别与孤独症组匹配的正常儿童作为对照组,被动观看电脑屏幕显示的高兴、悲伤、惊讶、愤怒和恐惧5种面部基本情绪表情图,观察比较两组幼儿对各种面部表情的视觉注意行为和自身情绪反应。结果研究期间孤独症组和对照组均纳入45例,两组幼儿对各种面部表情的初次注视时间组间效应不明显,而表情效应明显,两组幼儿初次注视高兴和愤怒表情的时间长于注视恐惧表情的时间。但孤独症组对各种面部表情图的回看次数明显少于对照组,总注视时间也明显短于对照组。对照组对不同的面部表情自身情绪反应评分明显不同,对高兴表情的积极情绪评分明显高于其他表情,对高兴表情的消极情绪评分明显低于愤怒和恐惧表情,对悲伤和惊讶表情的消极情绪评分也明显低于恐惧表情。而孤独症组对各种情绪表情的自身情绪反应评分差异无统计学意义。结论孤独症患儿早期不仅对面部情绪表情的视觉注意减少,对面部情绪表情的感知也存在缺陷,尤其对各种负性情绪表情理解困难。     

Cognitive abilities in siblings of children with autism spectrum disorders

The aim of the present study was to assess the cognitive profiles of children with autistic spectrum disorder and of their healthy siblings (Siblings). With the term cognitive profile, we indicate the relationship extant among the values of verbal and performance subtests of the Wechsler Intelligence Scale. The conducted statistical analyses indicated that, although siblings showed a normal intelligent quotient and did not differ in this aspect from typically developing group, their cognitive profile was amazingly similar to that of their relatives affected by autism. A k-means clustering analysis on the values of single subtests further confirmed this result, showing a clear separation between typically developing children on the one side, and autistics and their siblings on the other. We suggest that the common cognitive profile observed in autistic children and their siblings could represent a marker of liability to autism and, thus, a possible intermediate phenotype of this syndrome.     

Predicting ensuing actions in children and adolescents with autism spectrum disorders

This study investigated the ability to predict others’ action in a group of children and adolescents with autism spectrum disorders (ASD) (n = 18). Their performance was compared with a group of children with mental retardation (n = 13) and a group of children with typical development (n = 19). Participants were presented with short incomplete videotaped movies showing an actor executing familiar and non-familiar actions. When asked to predict the outcome, participants with ASD produced fewer correct responses and their performance did not improve for familiar actions, as compared to both comparison groups. In addition, they committed a greater number of errors of temporal inversion. These results provide new evidence that an impaired means-end analysis process, leading to a diminished sensitivity to the sequence structure of goal-directed actions, would disrupt the ability to understand and predict others’ actions. The comprehension of abnormalities in event knowledge provides a better insight of some of the problems that individuals with ASD encounter in spontaneously understanding real-life social situations.     

Cognitive appraisals,distress and disability among persons in low vision rehabilitation

Objective Examined cognitive appraisals of interference and tolerance in the prediction of distress and self‐reported disability among persons presenting for low vision rehabilitation. Design Cross‐sectional; correlational and path analyses. Methods One‐hundred and thirteen patients (mean age, 71 years; 52 men and 61 women) presenting for low vision rehabilitation at a university‐based centre for low vision rehabilitation participated in an initial clinical vision examination and completed several questionnaires to evaluate cognitive appraisals, emotional distress and self‐reported disability. Results Path analyses indicated that greater tolerance was associated with less interference imposed by vision loss. Greater tolerance was also associated with less emotional distress and symptom severity (visual acuity) was associated with self‐reported disability. Cognitive appraisals (tolerance and interference) indirectly influenced self‐reported disability through emotional distress. Conclusions The data indicate that appraisals of personal ability to tolerate vision loss and the perceived interference of vision loss on goal‐directed behaviour and expected activities have greater influence on distress and are subsequently predictive of disability in comparison with objective symptoms (visual acuity). Implications for clinical interventions and further research are discussed.     

孤独症儿童对静态和动态视向提示信息的加工

目的:探索在静态和动态呈现条件下孤独症儿童对视向提示信息加工的特征.方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)孤独症诊断标准的儿童和年龄性别匹配的正常对照儿童各10名.通过l张图片形成的静态视向提示和5张图片形成的动态视向提示,采用2(组别:孤独症儿童,正常儿童)×2(呈现方式:静态,动态)×2(提示性:有效提示,无效提示)的重复测量方差分析,比较两组儿童在不同呈现方式下的视向提示反应的正确率和反应时.结果:在静态条件下,孤独症儿童识别视向的正确率低于正常对照组儿童[(94.8±1.3)％vs.(99.5±1.3)％,P＜0.05],且反应时较长[(470.2±23.8) ms vs.(389.2±23.8) ms,P＜0.05];在动态条件下,有效提示的识别正确率高于无效提示[(98.8±0.5)％vs.(93.8±0.3)％,P＜0.05],且有效提示的反应时短于无效提示[(463.1±19.7) ms vs.(504.8 ±21.4) ms,P＜0.01],孤独症儿童的反应时长于正常对照组儿童[(544.6±28.4) ms vs.(423.3±28.4) ms,P＜0.05].结论:本研究发现提示孤独症儿童存在与正常儿童一样的视向注意转移,并无特异性视向注意损伤,孤独症儿童对动态视向信息加工可能较静态视向信息加工更敏感.     

Sleep problems in adolescents with Asperger syndrome or high-functioning autism

Background

Autism is a neurodevelopmental disorder defined by deficits in social interaction, communication, and restricted repetitive behavior. Research studies indicate that children with autism spectrum disorders suffer from more sleep problems than the general population.

Objective

The aim of the study was to investigate sleep problems in adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and to further examine the association between sleep problems and problem behavior as well as autism symptom severity.

Methods

In this study, 15 adolescents diagnosed with AS or HFA (aged between 10–19 years) and one parent of each answered questions about sleep and sleep disturbances.

Results

A high prevalence of sleep problems (80?%) was found. The most frequently reported sleep problems were insomnia symptoms (80?%) and parasomnias (53?%). More sleep problems were associated with decreased daytime functioning, more precisely with more externalizing problem behavior and a higher autism symptom severity.

Conclusion

The results suggest that sleep problems are common in adolescents with AS or HFA and are connected to lower daytime functioning. Therefore, in clinical practice, individuals should routinely be screened for sleeping difficulties.

     

孤独症儿童母亲亲职压力的6个月随访

目的:探讨孤独症儿童母亲在养育和照料患儿过程中亲职压力的变化趋势及相关因素.方法:选取符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)孤独症诊断标准的78名儿童及其母亲(n=78),研究基线时使用0～6儿童神经心理发育量表、婴儿-初中生社会生活能力量表、儿童孤独症评定量表(CARS)、孤独症行为评定量表(ABC)评估儿童的发育商、适应行为、疾病严重程度、行为问题;采用流调用抑郁自评量表(CES-D)、焦虑自评量表(SAS)、亲职压力指标简表(PSI-SF)评估孤独症儿童母亲抑郁状态、焦虑状态及亲职压力水平.分别在研究3个月和研究6个月时再次使用亲职压力指标简表(PSI-SF)对母亲亲职压力进行评估.结果:3个月与6个月时,母亲的亲职压力指标简表中亲职压力总分[(101.9±17.9),(99.9±17.6) vs.(103.1±18.6)]、亲职愁苦得分[(35.3±9.4),(33.7±8.5)vs.(36.9±8.3)]均低于基线(P＜0.05);3个月时困难儿童得分高于6个月时得分[(34.6±8.1)vs.(32.5±7.2),P＜0.05],但与研究基线相比差异无统计学意义.多层线性模型分析显示,6个月中母亲亲职压力指标简表得分呈下降趋势(P＜0.001),与基线相比,3个月、6个月时母亲亲职压力指标简表的得分每隔3个月分值降低1.19.基线时,孤独症儿童的婴儿-初中生社会生活能力量表得分与母亲的PSI-SF得分呈负相关(β=-0.20,P＜0.01),儿童的CARS(β=0.92,P＜0.01)及母亲的CES-D(β=0.69,P＜0.01)、SAS (β=0.89,P＜0.01)均与母亲的PSI-SF得分呈正相关.儿童的婴儿～初中生社会生活能力量表得分(β=-0.02,P＜0.05)及母亲的SAS得分(β=0.1,P＜0.01)与6个月时的母亲亲职压力指标简表得分仍然相关.结论:孤独症儿童母亲存在较高的亲职压力,母亲焦虑程度越高、儿童适应行为能力越低时母亲亲职压力可能越高.     

Evidence-based assessment of autism spectrum disorders in children and adolescents.

This article reviews evidence-based criteria that can guide practitioners in the selection, use, and interpretation of assessment tools for autism spectrum disorders (ASD). As Mash and Hunsley (2005) discuss in this special section, evidence-based assessment tools not only demonstrate adequate psychometric qualities, but also have relevance to the delivery of services to individuals with the disorder (see also Hayes, Nelson, & Jarrett, 1987). Thus, we use what is known about the symptoms, etiologies, developmental course, and outcome of ASD to evaluate the utility of particular assessment strategies and instruments for diagnosis, treatment planning and monitoring, and evaluation of outcome. The article begins with a review of relevant research on ASD. Next we provide an overview of the assessment process and some important issues that must be considered. We then describe the components of a core (minimum) assessment battery, followed by additional domains that might be considered in a more comprehensive assessment. Domains covered include core autism symptomatology, intelligence, language, adaptive behavior, neuropsychological functions, comorbid psychiatric illnesses, and contextual factors (e.g., parent well-being, family functioning, quality of life). We end with a discussion of how well the extant literature meets criteria for evidence-based assessments.     

Grief reactions of mothers of adolescents and young adults with traumatic brain injury.

One hundred and two mothers of adolescents and young adults with traumatic brain injury completed a modified Grief Experience Inventory (GEI) (Sanders, Mauger, & Strong, 1985) and rated their child's functioning on a modified Neurobehavioral Rating Scale (NRS) (Levin et al., 1987). More severe grief was reported by mothers who rated their children as having poor neurobehavioral functioning and by mothers of young adult rather than adolescent patients. The guilt component of grief varied significantly across the 3-year post-injury period measured in the study. Historical comparisons of these respondents with other bereaved populations showed that mothers of adolescent and young adults with head injury reported more intense grief than parents who had experienced other significant non-death losses.     

Association of the oxytocin receptor gene (OXTR) in Caucasian children and adolescents with autism

The oxytocin receptor gene (OXTR) has been studied in autism because of the role of oxytocin (OT) in social cognition. Linkage has also been demonstrated to the region of OXTR in a large sample. Two single nucleotide polymorphisms (SNPs) and a haplotype constructed from them in OXTR have been associated with autism in the Chinese Han population. We tested whether these associations replicated in a Caucasian sample with strictly defined autistic disorder. We genotyped the two previously associated SNPs (rs2254298, rs53576) in 57 Caucasian autism trios. Probands met clinical, ADI-R, and ADOS criteria for autistic disorder. Significant association was detected at rs2254298 (p=0.03) but not rs53576. For rs2254298, overtransmission of the G allele to probands with autistic disorder was found which contrasts with the overtransmission of A previously reported in the Chinese Han sample. In both samples, G was more frequent than A. However, in our Caucasian autism trios and the CEU Caucasian HapMap samples the frequency of A was less than that reported in the Chinese Han and Chinese in Bejing HapMap samples. The haplotype test of association did not reveal excess transmission from parents to affected offspring. These findings provide support for association of OXTR with autism in a Caucasian population. Overtransmission of different alleles in different populations may be due to a different pattern of linkage disequilibrium between the marker rs2254298 and an as yet undetermined susceptibility variant in OXTR.     

Physiological linkage and affective dynamics in dyadic interactions between adolescents and their mothers

This study examined physiological linkage (specifically, linkage in respiratory sinus arrhythmia; RSA) between parents and youth (aged 11–17) across conflict and fun activity discussion tasks. We also examined whether observed, momentary negative affect or parental depressive symptoms, would moderate patterns of RSA linkage across the interaction tasks. RSA linkage was assessed using a multilevel actor–partner interdependence model (APIM). Participants were 59 mother–adolescent dyads, including mothers with or without clinically significant depressive symptoms. Both mothers and teens evidenced stable RSA over time (actor effect), although the stability of maternal RSA was moderated by maternal depression, with maternal depressive symptoms related to slower RSA return to baseline. There was a significant partner influence on youth RSA, with maternal RSA positively related to subsequent youth RSA. However, this effect was moderated by maternal depression and maternal negative affect (NA), with low maternal depression/low maternal NA related to dyadic synchrony, whereas high depression or high NA led to attenuation of this relationship. Results demonstrate the importance of understanding the dynamic and complex nature of family interactions in the context of depression.     

Cortisol profiles differentiated in adolescents and young adult males with fragile X syndrome versus autism spectrum disorder

Background

Fragile X syndrome (FXS) and non‐syndromic autism spectrum disorder (ASD) are distinct disorders with overlapping behavioral features. Both disorders are also highly associated with anxiety with abnormal physiological regulation implied mechanistically. Some reports suggest atypical hypothalamus‐pituitary‐adrenal (HPA) axis function, indexed via aberrant cortisol reactivity, in both FXS and non‐syndromic ASD. However, no study has compared cortisol reactivity across these two disorders, or its relationship to ASD symptom severity.

Methods

Cortisol reactivity (prior to and following a day of assessments) was measured in 54 adolescent/young adult males with FXS contrasted to 15 males with non‐syndromic ASD who had low cognitive abilities.

Results

Greater ASD symptom severity was related to increased cortisol reactivity and higher levels at the end of the day, but only in the non‐syndromic ASD group. Elevated anxiety was associated with increased HPA activation in the group with FXS alone.

Conclusions

Taken together, findings suggest a unique neuroendocrine profile that distinguishes adolescent/young adult males with FXS from those with non‐syndromic ASD. Severity of ASD symptoms appears to be related to cortisol reactivity in the non‐syndromic ASD sample, but not in FXS; while anxiety symptoms are associated with HPA activation in the FXS sample, but not in ASD despite a high prevalence of ASD, anxiety and physiological dysregulation characteristic in both populations.