Autistic traits in the general population: What mediates the link with depressive and anxious symptomatology?

The high prevalence of anxiety disorders and depression within the autism spectrum disorder (ASD) population is widely recognised. This study examined the role of three potential mediating variables in the relationship between autistic traits and depressive/anxious symptomatology in the general population. Participants included 231 university students (114 males, 117 females) ranging in age from 17 to 35 (M = 18.9, SD = 2.77). Participants completed five standardised questionnaires which measured: autistic traits, depressive/anxious symptomatology, social competence, social problem-solving ability, and teasing history. Two multiple mediation analyses were conducted using the bootstrapping method. Results revealed that social problem-solving ability and past teasing experiences were significant partial mediators in the relationship between autistic traits and depressive symptoms. However, contrary to expectations, social competence was not a significant mediator in the relationship between autistic traits and depressive symptoms. In addition, social problem-solving ability and past teasing experiences were significant partial mediators in the relationship between autistic traits and anxiety symptoms. This suggests that interventions to reduce anxious and depressive symptomatology in the ASD population should focus upon improving social problem-solving ability and reducing bullying experiences at school. These initial findings should be confirmed in the ASD population in future research.     

Treatment approach,autism severity and intervention outcomes in young children

The current study examined the relation between autism severity at baseline, type of intervention employed and outcomes in young children with autism spectrum disorder (ASD). Seventy-eight children with ASD, aged 15–35 months (M = 25.4, SD = 4.2), received either applied behavioral analysis (ABA) or integration of several intervention approaches (Eclectic) in community center-based programs. Outcome was measured after 1 year of intervention using standardized autism diagnostic tests, and cognitive and adaptive skills evaluations. ASD diagnosis was highly stable (99%). Both intervention groups improved significantly in verbal cognitive abilities and in socialization and communication adaptive skills, but no significant difference between the intervention groups was documented. Less severe autism symptoms at baseline were associated with better progress in adaptive skills and in cognitive abilities. Within the group with less severe autism symptoms, those who received Eclectic intervention had a better outcome than those who received ABA in communication and socialization adaptive skills as reported by the parents, but not in the standardized cognitive test results. The child's baseline social abilities and deficits appear to be crucial variables for intervention outcomes and should be considered in treatment approach decision-making.     

The relationship between autism spectrum disorders and anxiety: The moderating effect of communication

Communication skills have been shown to have differing effects on levels of anxiety depending on whether or not a child has an autism spectrum disorder (ASD) or is typically developing. This article examined whether or not communication deficits differentially affect children with ASD compared to those without ASD. Ninety-nine children with autistic disorder (n = 33), Pervasive Developmental Disorder – Not Otherwise Specified (PDD-NOS; n = 33), and no diagnosis (n = 33) were examined using the Autism Spectrum Disorders Diagnostic for Children and Comorbidity for Children scales to determine their level of anxiety and degree of communication deficits. Results indicated that anxiety decreased as communication deficits increased for those with autistic disorder compared to those with PDD-NOS or no diagnosis; however, for those with PDD-NOS anxiety increased as communication deficits increased compared to those with no diagnosis. The importance and differential impact of communication deficits on anxiety for different groups is highlighted.     

The relationship of motor skills and adaptive behavior skills in young children with autism spectrum disorders

ObjectiveTo determine the relationship of motor skills and adaptive behavior skills in young children with autism.DesignA multiple regression analysis tested the relationship of motor skills on the adaptive behavior composite, daily living, adaptive social and adaptive communicative skills holding constant age, non-verbal problem solving, and calibrated autism severity.SettingMajority of the data collected took place in an autism clinic.ParticipantsA cohort of 233 young children with ASD (n = 172), PDD-NOS (n = 22) and non-ASD (developmental delay, n = 39) between the ages of 14–49 months were recruited from early intervention studies and clinical referrals. Children with non-ASD (developmental delay) were included in this study to provide a range of scores indicted through calibrated autism severity.InterventionsNot applicable.Main outcome measuresThe primary outcome measures in this study were adaptive behavior skills.ResultsFine motor skills significantly predicted all adaptive behavior skills (p < 0.01). Gross motor skills were predictive of daily living skills (p < 0.05). Children with weaker motor skills displayed greater deficits in adaptive behavior skills.ConclusionsThe fine and gross motor skills are significantly related to adaptive behavior skills in young children with autism spectrum disorder. There is more to focus on and new avenues to explore in the realm of discovering how to implement early intervention and rehabilitation for young children with autism and motor skills need to be a part of the discussion.     

Assessment of joint attention in school-age children and adolescents

Joint attention (JA), the ability to share attention to an object or event with another person, is one of the earliest identified deficits in autism spectrum disorders (ASD) and directly influences language and social development. There are several effective assessments of JA for young children (e.g., Mundy et al., 2003), but none are appropriate for school-age or adolescence. We developed a measure of response to JA and assessed individuals with ASD (n = 18) and typical development (n = 24), ages 7 to 17. Six naturalistic prompts were interleaved throughout a testing session. Discriminative validity was high: there was a broad range for both groups, though scores were lower for children with ASD. Scores in the ASD group were associated with receptive language, symptomatology, and theory of mind. Reliability across examiners was high (κ = .875). This measure, which requires no special equipment and minimal training, was useful in capturing JA skills in older individuals with and without ASD. Further, scores were associated with theoretically related skills, indicating high external validity. Given the powerful developmental sequelae and numerous interventions for JA, this measure offers a longitudinal assessment opportunity.     

Examining the effectiveness of peer-mediated and video-modeling social skills interventions for children with autism spectrum disorders: A meta-analysis in single-case research using HLM

Social interaction is a fundamental problem for children with autism spectrum disorders (ASD). Various types of social skills interventions have been developed and used by clinicians to promote the social interaction in children with ASD. This meta-analysis used hierarchical linear modeling (HLM) to examine the effectiveness of peer-mediated and video-modeling approaches, the two approaches that are most commonly used for social skills training of children with ASD. The two approaches, with the average effect size of 1.27 (peer-mediated approach: mean = 1.3, 95% CL = 1.10–1.50, N = 9; video-modeling approach: mean = 1.22, 95% CL = 0.65–1.78, N = 5) were found to significantly and equally improve the social performance of children with ASD. In addition, age functioned as a significant moderator in the effectiveness of the intervention. Implications of the results and limitations of this study are discussed.     

Autism spectrum disorder and the student teacher relationship: A comparison study with peers with intellectual disability and typical development

This study examined relations among behavior problems, social skills, and student–teacher relationships within a sample of children (mean age 8) with autism spectrum disorders or ASD (n = 36) and comparison samples of children with typical development (n = 91) or with intellectual disability (n = 38.) Student–teacher relationships (STRs) for children with ASD appeared to be qualitatively different from those of similarly aged children with ID or typical development. The STRs for children with ASD were considerably poorer, with less closeness and more conflict, than in the two comparison groups. Within the group with ASD, teacher-reported child externalizing behavior and social skills accounted for significant variance in the total score on the Student Teacher Relationship Scale. Conflict was predicted only by externalizing behavior, whereas closeness was predicted by social skills; level of autistic mannerisms negatively related to the teacher's perception of closeness. Findings address the implications for transition to early schooling for children with ASD.     

Broader autism phenotype as a risk factor for postpartum depression: Hamamatsu Birth Cohort (HBC) Study

The broader autism phenotype (BAP), which refers to the expression of behavioral and cognitive propensities that are milder but qualitatively similar to those defining autism spectrum disorder, can play a crucial role in postpartum depression (PPD). We investigated whether pregnant women's BAP would increase the risk for PPD, using a representative birth cohort in Japan. Pregnant women were enrolled in the Hamamatsu Birth Cohort (HBC) Study during their mid-gestation (N = 841) and were followed up until 3 months after delivery. BAP was measured mainly during the 2nd trimester of the pregnancy by using the Broader Phenotype Autism Symptoms Scale. Participants scoring 9 points or higher on the Edinburgh Postnatal Depression Scale at least once during the first 3 months after childbirth were diagnosed with PPD. Among participants, 128 (15.2%) women were found to have PPD. Multiple logistic regression analyses showed that BAP were associated with PPD (OR = 1.19, 95% CI [1.07–1.31]), even after controlling for other potential confounders. In addition, the association was not moderated by history of depression and/or anxiety disorders, including concurrent depressive and anxiety symptoms during pregnancy. The findings suggest that pregnant women with BAP have an elevated risk for PPD.     

The mediation effect of health literacy between subjective social status and depressive symptoms in patients with heart failure

ObjectivesDepressive symptoms are prevalent and cause adverse outcomes in heart failure. Previous studies have linked depressive symptoms with socioeconomic status. However, little is known about the mechanisms underlying this relationship. This study aimed to evaluate the association between socioeconomic status and depressive symptoms, and to examine whether access to healthcare, health literacy and social support mediated this relationship in patients with heart failure.MethodsCross-sectional design was used to study 321 patients with heart failure recruited from a general hospital. Demographics, clinical data, depressive symptoms, socioeconomic status (i.e., education, employment, income, and subjective social status), access to healthcare, health literacy, and social support were collected by patient interview, medical record review or questionnaires. A series of logistic regressions and linear regressions were conducted to examine mediation.ResultsThe mean age of patients with heart failure was 63.6 ± 10.6 years. Fifty-eight patients (18%) had depressive symptoms. Lower subjective social status (OR = 1.321, p = 0.012) and lower health literacy (OR = 1.065, p < 0.001) were separately associated with depressive symptoms. When subjective social status and health literacy were entered simultaneously, the relationship between subjective social status and depressive symptoms became non-significant (OR = 1.208, p = 0.113), demonstrating mediation. Additionally, lower social support was associated with depressive symptoms (OR = 1.062, p = 0.007).ConclusionsIn patients with heart failure, health literacy mediated the relationship between subjective social status and depressive symptoms. Lower social support was associated with depressive symptoms. Interventions should take these factors into account.     

Self-reported social skills impairment explains elevated autistic traits in individuals with generalized social anxiety disorder

Screening for autism in individuals with generalized social anxiety disorder (GSAD) is complicated by symptom overlap between GSAD and autism spectrum disorder (ASD). We examined the prevalence of self-reported autistic traits within a sample of participants with a diagnosis of GSAD (n = 37) compared to individuals without a GSAD diagnosis (NOSAD; n = 26). Of the GSAD sample participants, 70.84% self-reported autistic traits above a cut-off of 65 on the Autism Quotient-Short (AQ-S) and reported significantly more autistic traits on 3 of 5 AQ-S subscales compared to the NOSAD group. Diagnosis uniquely predicted variation in the social skills subscale above and beyond the other subscales and other predictors. Furthermore, variation in the social skills subscale largely explained group differences on the other subscales. Our results suggest caution in utilizing measures like the AQ-S with clinical populations characterized by social difficulties such as individuals with a GSAD diagnosis.     

Depression inhibits the anti-inflammatory effects of leisure time physical activity and light to moderate alcohol consumption

Light to moderate alcohol consumption and leisure time physical activity (LTPA) are independently associated with lower levels of high sensitivity C-reactive protein (CRP), a predictor of cardiometabolic risk. In contrast, depression, ranging from low mood disturbance to major depressive disorder, has been associated with elevated CRP. To test the hypothesis that depression attenuates the anti-inflammatory effects of LTPA and alcohol consumption, the current study tested the moderating effect of severity of depressive symptomatology on the relation of alcohol consumption and LTPA to CRP in 222 healthy adult men and women (18–65 years of age). Given the known effects of gender on inflammation, we also examined the effects of gender on the tested interactions. Depression was assessed using the Beck Depression Inventory. Frequency of alcohol consumption, hours of LTPA per week and other coronary risk/protective factors were assessed via self-report and structured interview. Fasting blood samples were used to measure CRP and lipids. As predicted, the interaction between LTPA and depressive symptomatology was significant (F = 5.29, p < .03) such that lower CRP was associated with the combination of decreased depressive symptomatology and increased LTPA. Among those with increased depressive symptoms, increased LTPA was not associated with higher CRP. Similarly, depression interacted with alcohol consumption in predicting CRP in men but not women (F = 5.03, p < .008) such that for men light to moderate alcohol consumption was associated with lower CRP but only among those with decreased depressive symptoms. Light to moderate alcohol consumption was not associated with lower CRP in those with increased depressive symptom severity. The pattern of the interactions between anti-inflammatory activities such as light to moderate alcohol consumption and LTPA and psychological distress as indexed by severity of depressive symptomatology suggests an important new avenue for future research.     

Role of parental occupation in autism spectrum disorder diagnosis and severity

Some have suggested that parents of children with autism spectrum disorder (ASD) may present with less recognizable autistic-like phenotypic characteristics, leading them to highly systemizing occupations. Using secondary analysis of data from two previous studies of children with ASD, we tested associations between parental occupations and ASD diagnosis and the association of parental occupational characteristics on ASD severity. We found that fathers in healthcare (P < 0.01) and finance (P = 0.03) were more likely to have children with ASD. Additionally, joint effects of parental technical occupations were associated with communication (P < 0.01) and social impairment (P = 0.04). These results support that a “broader phenotype” and possible assortative mating in adults with autistic-like characteristics might contribute to intergenerational transmission and having offspring with greater ASD severity.     

Efficacy of cognitive behavior therapy-based social skills intervention for school-aged boys with autism spectrum disorders

School-aged children with Autism Spectrum Disorders (ASD) experience significant difficulty with peer interaction. Research to identify the most effective strategies to address this difficulty has increased but more evidence is needed. Cognitive behavior therapy (CBT), which focuses on changing how a person thinks about social situations as well as how he behaves, is a promising approach. This study evaluated the efficacy of a 15 week CBT-based social skills intervention for boys aged 10–12 years diagnosed with an ASD. Boys with average or better IQ and receptive language skills were randomly assigned to either a control (n = 8) or intervention condition (n = 7). During intervention, boys attended weekly 2 h long group sessions focusing on self-monitoring skills, social perception and affective knowledge, conversation skills, social problem-solving, and friendship management skills. Comparison of the outcomes using repeated measures analyses indicated that boys receiving the intervention scored significantly better on measures of social perception, peer interaction, and social knowledge than boys who had not received intervention. There were no differences on general measures of socialization. The manualized intervention used in this study shows promise but replication with larger samples is needed.     

Depressive symptoms and disability in chagasic stroke patients: Impact on functionality and quality of life

IntroductionChagas disease (CD) is associated with stroke, which can result in significant long-term disability. Stroke has also been associated with depressive symptoms, which affect functional performance and quality of life (QOL). Few data are available on the effect of chagasic stroke on functional performance and QOL.ObjectivesThis study aimed to investigate the correlation of stroke disability and depressive symptoms with functional performance and QOL in chagasic stroke patients.MethodsIn this cross-sectional study, stroke sequelae were assessed using the Modified Rankin Stroke Scale (MRSS), depressive symptoms using the Beck Depression Inventory (BDI), functional performance using the Barthel Index (BI), and QOL using the WHOQOL-BREF.ResultsTwenty-one patients with CD and a previous diagnosis of stroke were included. There was a correlation between the MRSS score and the BI score (r = ? 0.663, p = 0.003), but not the scores of the WHOQOL-BREF subscales. The BDI score was correlated with the WHOQOL-BREF subscale scores (Physical: r = ? 0.733, p = 0.001; Psychological: r = ? 0.581, p = 0.012; Social: r = ? 0.713, p = 0.001; Environmental: r = ? 0.659, p = 0.003). However, the BDI score was not associated with the BI score (r = 0.279, p = 0.262).ConclusionsQOL in patients with CD appears to be influenced more by depressive symptoms than by the motor-associated consequences of stroke. Conversely, motor sequelae impair the functionality of the patient more than depressive symptoms.     

Corpus callosum area in children and adults with autism

Despite repeated findings of abnormal corpus callosum structure in autism, the developmental trajectories of corpus callosum growth in the disorder have not yet been reported. In this study, we examined corpus callosum size from a developmental perspective across a 30-year age range in a large cross-sectional sample of individuals with autism compared to a typically developing sample. Midsagittal corpus callosum area and the 7 Witelson subregions were examined in 68 males with autism (mean age 14.1 years; range 3–36 years) and 47 males with typical development (mean age 15.3 years; range 4–29 years). Controlling for total brain volume, increased variability in total corpus callosum area was found in autism. In autism, increased midsagittal areas were associated with reduced severity of autism behaviors, higher intelligence, and faster speed of processing (p = 0.003, p = 0.011, p = 0.013, respectively). A trend toward group differences in isthmus development was found (p = 0.029, uncorrected). These results suggest that individuals with autism benefit functionally from increased corpus callosum area. Our cross-sectional examination also shows potential maturational abnormalities in autism, a finding that should be examined further with longitudinal datasets.     

Hyper-responsiveness to touch mediates social dysfunction in adults with autism spectrum disorders

This study investigated whether hyper-responsiveness to touch serves as a mediating variable that predicts social dysfunction in adults with autism spectrum disorders (ASD). Data were obtained from all adults with administratively defined intellectual disability in a region in Sweden (n = 915, where 143 had ASD). A multiple mediation modeling analysis revealed a well-fitted model (Satorra–Bentler scaled chi-square = 10.91, df = 7, p = 0.14, CFI = 0.99, RMSEA = 0.025), demonstrating that social dysfunction among adults with ASD was completely mediated by hyper-responsiveness to touch followed by impairment of speech and aggressive/destructive behavior. The results demonstrated that in adulthood, the tactile sensory system is foundational for social functioning in people with ASD, with diagnosis and intervention implications.     

Early language milestones predict later language,but not autism symptoms in higher functioning children with autism spectrum disorders

Language ability is a known predictor of outcome in children with autism but plays a more controversial role for higher functioning children with autism spectrum disorders (ASD). We studied the relationship between early language milestones and later structural language, adaptive functioning and autism symptoms in a sample of 76 children (mean age = 9.1 years) with an ASD, using two different language milestones: first phrase by 24 or 36 months. After controlling for age and nonverbal abilities, retrospectively reported early language milestones were predictive of later structural language abilities, measured by a sentence repetition task, and adaptive communication skills, but not autism symptoms or adaptive social skills. Acquisition of phrase speech by 24 months was sensitive to language and communication impairments in our ASD group, the majority (84%) of which had already acquired phrase speech by 36 months of age. Early available and easily collectable milestone data may be a useful marker of later language performance even in higher functioning, verbal children on the autism spectrum. When a detailed assessment of language is not possible, data on early milestones may be useful for identifying children at-risk in clinical settings and for language phenotyping in the laboratory.     

Anti-brain antibodies are associated with more severe cognitive and behavioral profiles in Italian children with Autism Spectrum Disorder

Circulating 45 and 62 kDa antibodies targeting the cerebellum were previously associated with Autism Spectrum Disorder (ASD), lower adaptive/cognitive function and aberrant behaviors. Moreover, 37, 39 and 73 kDa maternal antibodies (mAb) targeting the fetal brain were previously correlated with broad autism spectrum, irritability, abnormal brain enlargement and impaired expressive language. The present study aims towards clinically characterizing individuals with brain-targeted IgG and/or exposed to maternal antibrain antibodies in a large sample of Italian autistic children (N = 355), their unaffected siblings (N = 142) and mothers (N = 333). The presence of patient- and mother-produced anti-brain antibodies does not confer increased risk of autism within the same sibship. However, the 45 and 62 kDa antibodies are correlated with autism severity: the 45 kDa Ab is associated with cognitive impairment and lower scores at the Vineland Adaptive Behavior Scales, the 62 kDa Ab with motor stereotypies, while both correlate with larger head circumference (all P < 0.05). On the other hand, maternal 37, 39 and 73 kDa antibrain antibodies, either alone or in combination, are correlated with impaired verbal and non-verbal language development, neurodevelopmental delay and sleep/wake cycle disturbances in their autistic children (P < 0.05). Presence of the 62 kDa autoAb in the child is significantly associated with presence of the 39 and/or 73 kDa antibodies in his/her mother. Our results confirm and extend previous observations in an ethnically distinct sample, providing further evidence of a pathomorphic role for anti-brain antibodies in autism while demonstrating their familial clustering.     

The relationship between atypical visual processing and social skills in young children with autism

The present study examined whether atypical visual processing is related to the level of social skills in children with autism spectrum disorder (ASD). Thirty-eight young children with ASD (29 boys, 9 girls) were included. Atypical visual processing was assessed by coding the number of lateral glances and the amount of object grouping behavior on videotaped observations of the ADOS (aged 35 ± 9 months). The level of social skills was measured using the subscale interpersonal relationships of the Vineland SEEC (32 ± 7 months). A negative relationship with a medium effect size was found between lateral glances and interpersonal relationships. Object grouping behavior and interpersonal relationships were not related. This study suggests that visual perception may be a mechanism in the development of interpersonal relationships in ASD, which is in accordance with an embodied approach to social cognition.     

Inattention and hyperactivity in association with autism spectrum disorders in the CHARGE study

BackgroundAttention deficits in young children with autism spectrum disorder (ASD) are not well understood. This study sought to determine: 1) the prevalence of ADHD symptoms in young children with ASD, typical development (TD), and developmental delay (DD) and 2) the association between ADHD symptoms and cognitive and behavioral functioning in children with ASD.MethodADHD symptoms, defined according to Aberrant Behavior Checklist (ABC) hyperactivity subscale scores, were compared across children aged 2–5 from a large case-control study with ASD (n = 548), TD (n = 423), and DD (n = 180). Inattention and hyperactivity items within this subscale were also explored. Within the ASD group, linear and logistic regression were used to examine how ADHD symptoms were associated with cognition as assessed by the Mullen Scales of Early Learning and adaptive functioning as assessed by the Vineland Adaptive Behavior Scales.ResultsMean hyperactivity subscale scores were lowest in children with TD (mean = 3.19), higher in children with DD (12.3), and highest in children with ASD (18.2; between-group p < 0.001). Among children with ASD, significant associations were observed with higher ADHD symptoms and poorer adaptive and cognitive functioning (adjusted beta for hyperactivity score in association with: Vineland composite = −5.63, p = 0.0005; Mullen visual reception scale = −2.94, p = 0.02; for the highest vs. lowest quartile of hyperactivity score, odds of lowest quintile of these scores was approximately doubled). Exploratory analyses highlighted associations with inattention-related items specifically.ConclusionThese results suggest ADHD symptoms may play a key role in the functioning of young children with ASD.