Autism spectrum disorder symptoms in children with ADHD: A community-based study

This study examined the prevalence of autism spectrum disorder (ASD) symptoms in a community-based sample of children with attention-deficit/hyperactivity disorder (ADHD) and non-ADHD controls. We also examined the relationship between ASD symptoms and ADHD subtype, ADHD symptom severity and child gender. Participants were 6–10-year-old children (164 ADHD; 198 non-ADHD control) attending 43 schools in Melbourne, Australia, who were participating in the Children's Attention Project. ADHD was assessed in two stages using the parent and teacher Conners’ 3 ADHD index and the Diagnostic Interview Schedule for Children IV (DISC-IV). ASD symptoms were identified using the Social Communication Questionnaire (SCQ). Unadjusted and adjusted linear and logistic regression examined continuous and categorical outcomes, respectively. Children with ADHD had more ASD symptoms than non-ADHD controls (adjusted mean difference = 4.0, 95% confidence interval (CI) 2.8; 5.3, p < 0.001, effect size = 0.7). Boys with ADHD had greater ASD symptom severity than girls with ADHD (adjusted mean difference = 2.9, 95% CI 0.8; 5.2, p = 0.01, effect size = 0.4). Greater ADHD symptom severity was associated with greater ASD symptom severity (regression co-efficient = 1.6, 95% CI 1.2; 2.0, p < 0.001). No differences were observed by ADHD subtype. Greater hyperactive/impulsive symptoms were associated with greater ASD symptoms (regression coefficient = 1.0; 95% CI 0.0; 2.0, p = 0.04) however, this finding attenuated in adjusted analyses (p = 0.45). ASD symptoms are common in children with ADHD. It is important for clinicians to assess for ASD symptoms to ensure appropriate intervention.     

Impact of ADHD symptoms on autism spectrum disorder symptom severity

Despite the official exclusion criteria for autism spectrum disorder (ASD) and attention deficit/hyperactivity disorder (ADHD) in the DSM-IV and ICD-10, patients with ASD often show ADHD symptoms. We aimed to examine the potential influence of ADHD symptoms on autistic psychopathology in a large sample of patients with ASD. We tested the hypothesis that patients with ASD and an additional ADHD (ASD+) would show a higher severity of autistic symptoms than those with ASD only (ASD?). We measured autistic symptoms using the autism diagnostic observation schedule (ADOS-G), the autism diagnostic interview (ADI-R), and the social responsiveness scale (SRS). To measure overall psychopathology and ADHD symptoms, we used the child behavior checklist (CBCL) and the ADHD rating scale (FBB-ADHS), respectively. Group differences between the ASD+ and the ASD? group (group division was conducted according to the results of the FBB-ADHS) were calculated using a univariate analysis of variance (ANOVA). The ASD+ group showed a greater severity of autistic symptoms than the ASD? group, measured by the SRS and the ADI-R. Especially in the social interaction subscale (ADI-R), a significantly higher symptom severity was found in the ASD+ group. No significant group differences were found regarding autistic symptoms measured by the ADOS-G. Patients with ASD and an additional ADHD expressed a stronger severity of autistic symptoms than patients with ASD only. According to our results, the possibility of a co-diagnosis of ADS and ADHD, as is being planned in the DSM-5, is in line with earlier studies, is highly reasonable, will simplify research, and have therapeutic implications.     

Women's posttraumatic stress symptoms and autism spectrum disorder in their children

Maternal posttraumatic stress disorder (PTSD) may be associated with autism spectrum disorder (ASD) in offspring through multiple pathways: maternal stress may affect the fetus; ASD in children may increase risk of PTSD in mothers; and the two disorders may share genetic risk. Understanding whether maternal PTSD is associated with child's ASD is important for clinicians treating children with ASD, as PTSD in parents is associated with poorer family functioning. We examined the association of maternal PTSD with offspring ASD in a large US cohort (N ASD cases = 413, N controls = 42,868). Mother's PTSD symptoms were strongly associated with child's ASD (RR 4–5 PTSD symptoms = 1.98, 95% CI = 1.39, 2.81; RR 6–7 symptoms = 2.89, 95% CI = 2.00, 4.18). Clinicians treating persons with ASD should be aware of elevated risk of PTSD in the mother. Genetic studies should investigate PTSD risk alleles in relation to ASD.     

Genes associated with autism spectrum disorder

Autism spectrum disorder (ASD) is a heterogeneous grouping of neurodevelopmental disorders characterized by impairment in social interaction, verbal communication and repetitive/stereotypic behaviors. Much evidence suggests that ASD is multifactorial with a strong genetic basis, but the underlying mechanisms are far from clear. Recent advances in genetic technologies are beginning to shed light on possible etiologies of ASD. This review discusses current evidence for several widely studied candidate ASD genes, as well as various rare genes that supports their relationship to the etiology of ASD. The majority of the data are based on molecular, cytogenetic, linkage and association studies of autistic subjects, but newer methods, including whole-exome sequencing, are also beginning to make significant contributions to our understanding of autism.     

Factors influencing treatment decisions by parents for their children with autism spectrum disorder

Studies examining the treatment choices of parents of children with autism spectrum disorder (ASD) have mostly addressed questions about the prevalence of certain treatments. Fewer studies have examined the factors that influence their treatment decisions. In this study, 18 parents of children with ASD rated treatments according to their knowledge about them and how effective they believed them to be. They then distributed tokens representing resources (i.e., money, time, and energy) amongst the treatments they were currently using, or would use were there fewer constraints. Finally, they distributed tokens amongst hypothetical treatments about which they were only given information regarding empirical support and immediacy of outcome. Without the constraints of cost and availability participants distributed resources broadly. However, participants showed a preference for empirical support over immediacy of treatment outcome.     

Catechol-O-methyltransferase Val158Met polymorphism and hyperactivity symptoms in Egyptian children with autism spectrum disorder

Catechol-O-methyltransferase (COMT) plays an important role in the catabolism of brain dopamine and norepinephrine, which have been implicated in the pathogenesis of Autism spectrum disorder (ASD) as well as in other neuropsychatric disorders. We aimed to investigate the association of COMT Val158Met gene polymorphism with ASD and to examine the influence of such genotypes on hyperactivity symptoms in ASD patients. Eighty ASD patients (mean age 9 ± 1.9 years) and 100 control children (mean age 8.9 ± 1.9 years) were examined. COMT Val58Met polymorphism was genotyped using Tetra-primer ARMS-PCR method. The clinical diagnosis of ASD and ADHD were confirmed according to the DSM-IV criteria for research. We found no significant difference in genotypes or alleles’ frequencies of COMT Val158Met polymorphism between ASD patients and control group. There was a significant association between COMT (Val/Val) genotype and both increasing CARS (p = 0.001) and hyperactivity scores (p = 0.006). Regarding Conner's Score, the DSM-IV hyperactive impulsive were significantly higher in Val/Val genotype than both Met/Val and Met/Met genotypes (p = 0.03). Our data suggested an association between COMT Val58Met polymorphism and hyperactivity symptoms in Egyptian children with ASD.     

Impaired representational gaze following in children with autism spectrum disorder

Using eye-tracking methodology, we compared spontaneous gaze following in young children with Autism Spectrum Disorder (mean age 5.8 years) to that of typically developing children (mean age 5.7 years). Participants saw videos in which the position of a hidden object was either perceptually visible or was only represented in another person’s mind. The findings indicate that children with Autism Spectrum Disorder were significantly less accurate in gaze following and observed the attended object for less time than typically developing children only in the Representational Condition. These results show that children with Autism Spectrum Disorder are responsive to gaze as a perceptual cue although they ignore its representational meaning.     

Psychiatric comorbidity associated with co-occurring autism spectrum disorder and substance use disorder

BackgroundAlthough both autism spectrum disorder (ASD) and substance use disorder (SUD) are both commonly comorbid with other psychiatric conditions, there is a paucity of research on the overlap of these disorders. The primary aim of the present study was to identify the prevalence of psychiatric comorbidities in young adults with SUD and ASD compared to those with ASD only.MethodMultivariate logistic regression controlling for age was used to compare the prevalence of psychiatric disorders in a sample of treatment-seeking adult outpatients with a) ASD without SUD and b) ASD with SUD. Psychiatric and SUD diagnoses were determined by semi-structured interview (SCID for DSM IV).ResultsThe sample included 42 patients with ASD only (mean age ± SD = 26.2 ± 8.9 years) and 21 with ASD and SUD (35.2 ± 12.6). High rates of psychopathology were found in both groups. Comorbid conduct disorder (CD) was significantly more prevalent in the ASD + SUD group (25 %) compared to those without SUD (5%; p < 0.05). There were no other significant differences between groups in the rates of non-conduct comorbid psychopathology.ConclusionIn both groups, rates of psychopathology were high with CD being significantly more common in young adults with ASD and SUD. These findings highlight the importance of screening for CD in individuals with ASD to mitigate the potential development of comorbid SUD. Further research is needed to determine if CD is a true risk factor for SUD in the ASD population and identify other risk factors.     

Relationship of autistic traits between parents and children with and without autism spectrum disorder

BackgroundAlthough parents with a child with autism spectrum disorder (ASD) have usually been identified as having the “broader autism phenotype”, empirical research on the differences in autistic-like characteristics between parents with and without ASD children has yielded inconsistent results.MethodThis survey of the autistic traits of parents and children was conducted in 119 parents with ASD children and 108 parents with typically developing (TD) children. Parents’ autistic traits were quantified using the Autism-Spectrum Quotient and children’s autistic traits were quantified using the Autism Spectrum Quotient—Children’s Version.ResultsThe autistic traits of ASD children were significantly higher than those of the TD children; however, autistic traits were similar between parents in the two groups. Furthermore, the correlations of autistic traits between parents and children were only significant for the TD group and not for the ASD group.ConclusionsThe current findings indicate that the relationship of autistic traits between parents and children exists in the TD group, and that the Autism-Spectrum Quotient may be used for parents as a screening aid to identify children who should be further screened for autistic traits.     

The effects of item preference and token reinforcement on sharing behavior exhibited by children with autism spectrum disorder

The current studies evaluated variables affecting sharing exhibited by children with autism spectrum disorder. Study 1 evaluated the effects of manipulating item preference on the level of assistance needed to exhibit sharing behavior for 4 children with autism. Item preference clearly affected 2 participants’ percentage of independent sharing. Preference did not have as clear of an effect for a third participant. However, sharing a high-preference item generally required a higher level of prompting (e.g., vocal prompts) to share. The fourth participant's percentage of independent sharing was not influenced by preference, and his independent sharing behavior was similar across item preference. Study 2 assessed the effectiveness of a token reinforcement procedure as an intervention designed to increase independent sharing of high-preference items for the two participants who did not independently share those items during Study 1. Independent sharing increased for both participants when the token procedure was in place and decreased when it was removed.     

Age-related trends in treatment use for children with autism spectrum disorder

Numerous and increasing treatment options face parents of children with autism spectrum disorder (ASD). This study sought to elucidate age-related trends in treatment use among children with ASD from the Simons Simplex Collection (SSC; n = 2758). Our goals were to: (a) explore frequencies of use for various treatment types between preschool and adolescence, and (b) statistically compare rates of treatment-type use by children of different ages. Results indicated high reliance on school-based treatments (e.g., speech and occupational therapies), though use of these types of treatments decreased with age. Use of most treatment types peaked during the preschool years and decreased with age, except psychotropic medication, which was used more by older children. A stable proportion of the sample across ages endorsed biomedical treatments (i.e., complementary alternative medicine; CAM). Percentages of treatment-type use at three different ages (representing early childhood, middle childhood, adolescence) via Pearson chi-square analyses indicated significant associations (α < .006) between age and use of these treatment types: private and school-based speech, private and school-based occupational therapy, intensive behavioral treatment, and psychotropic medication. Results are considered within an ecological-behavioral framework to offer potential explanations for age-related differences in treatment use (e.g., family factors, special education legislation).     

孤独症谱系障碍儿童眼动研究进展

孤独症谱系障碍(ASD)是一组以社交障碍为主的神经发育性疾病,患病率呈逐年增加的趋势,且未见特效疗法,为此早诊断、早干预尤为重要.近些年,通过眼动技术研究,发现ASD在生命早期便存在异常的注视模式,有望将此作为ASD早期检测和诊断的生物标志物.现从ASD儿童异常的眼动模式、研究范式、大脑相关区域的联系及面孔加工四个方面,对ASD儿童运用眼动技术的研究文献进行梳理总结,阐述最新研究成果.     

Assessment of feeding problems in children with autism spectrum disorder

There is growing, but inconsistent, literature on feeding problems for children with Autism Spectrum Disorder. The purposes of this study were to (a) investigate the relation of feeding problems to autism severity, (b) assess the validity of parent-report questionnaires widely used to assess feeding problems in terms of their relation to systematic behavior observations, and (c) determine the relation between child feeding behavior and family mealtime environment. Thirty-eight children and their parents participated in the study. Parents completed questionnaires, and both parents and children participated in mealtime observations. Results indicated that autism severity predicted scores on a measure of feeding problems as well as the duration of negative vocalizations during meal observations. Food Frequency Questionnaires better predicted behavior during meals than the Brief Mealtime Autism Behavior Inventory. Family environment alone did not explain feeding difficulties.     

Unique handwriting performance characteristics of children with high-functioning autism spectrum disorder

Knowledge about the handwriting performance characteristics of children with autism spectrum disorder (ASD) is scarce, despite this skill’s importance for their academic and social participation. The objective was to compare the handwriting process and product characteristics of children with high-functioning autism spectrum disorder (HFASD) to those of typically developing children to determine the best means of differentiation between the groups. Participants were 60 children, aged 9–12 years; 30 of them were diagnosed with HFASD, and 30 were aged and gender-matched typically developed controls. All participants performed three graded writing tasks on an electronic tablet, which is part of a computerized handwriting evaluation system (ComPET). Their paragraph copying product was then evaluated using the Hebrew Handwriting Evaluation (HHE). Significantly inferior handwriting performance among children with HFASD was found in both handwriting process and product measures. Significant correlations between these measures, supplemented with discriminant analysis and regression analysis results, emphasize unique handwriting performance dynamics among children with HFASD. Evaluation of the characteristics of both the handwriting process and product of children with HFASD may provide a more comprehensive picture of individual deficits. Identifying performance features may lead to more focused and adapted intervention and enhancement of school participation among these children.     

Everyday expressions of pain in children with and without autism spectrum disorder

BackgroundAnecdotal reports from parents suggest that their children with autism spectrum disorder (ASD) may have diminished pain experiences and expressions. In contrast, objective measures of pain have been used to document typical and enhanced expressions of pain in response to noxious stimuli (e.g., blood draw) among children with autism. The purpose of this study was to compare non-biased parental ratings of pain among children with and without ASD.MethodAs an everyday measure of pain, parents completed The Non-Communicating Children’s Pain Checklist (NCCPC-R) across two time windows (i.e., 2 h and 1 week) for 31 children with ASD and 19 children without ASD.ResultsThere were no significant group differences in everyday expressions of pain between children with and without ASD. However, in general, increased autism symptomology severity was associated with decreased parental ratings of pain expressions.ConclusionThese results continue to support a framework where children with ASD may have typical pain sensitivity, however, their expressions of pain may differ based on where individuals lie on the autism spectrum.     

The relationship between race and comorbid symptoms in infants and toddlers with autism spectrum disorder

Researchers have indicated that persons with autism spectrum disorder (ASD) population evince higher rates of comorbid symptoms. While the relationship between comorbid symptoms and factors such as autism symptom severity, IQ level, age, communication abilities, and degree of social impairment were previously examined, there has been limited research on the effect of race in this area. The current study examined the potential role of race in comorbid symptoms in toddlers with ASD and atypically developing toddlers without a diagnosis of ASD using The Baby and Infant Screen for Children with aUtIsm Traits – Part 2 (BISCUIT-Part 2). Based on the current findings, African-American toddlers evinced higher rates of comorbid symptoms than Caucasian toddlers and toddlers of other races. In addition, toddlers with ASD evinced higher rates of comorbid symptoms than atypically developing toddlers without a diagnosis of ASD. Implications regarding these findings are discussed.     

Variability in adaptive behaviour in young children with autism spectrum disorder

ABSTRACT

Background Understanding adaptive behaviour variability in children with autism spectrum disorder (ASD) may have important implications for early intervention. The purpose of this study was to explore whether autism symptom severity and caregiver depression affected adaptive behaviour in young children with ASD.

Method Data were collected from 60 primary caregivers of children aged 2–6 years with ASD. A factorial multivariate analysis of covariance was conducted to investigate if different levels of autism symptom severity and caregiver depression affected communication, socialisation, and daily living skills, after controlling for child age.

Results Findings suggest that only autism symptom severity accounted for significant variance in adaptive behaviour, with socialisation being most impacted. Although more than half of the caregivers reported heightened depressive symptoms, caregiver depression was not related to adaptive behaviour.

Conclusions Findings highlight the level of functional impairment that young children with ASD experience in relation to autism symptom severity.     

孤独谱系障碍患儿的感觉特征

目的 使用中文版儿童感觉剖析量表探讨孤独谱系障碍(ASD)患儿的感觉特点.方法 采用中文版儿童感觉剖析量表对66例ASD患儿和66名健康发育儿童进行评定,由监护人完成.分析孤独症患儿与健康儿童在感觉方面的差异.结果 除感觉剖析量表的口腔感觉处理和影响活动水平的运动的调节部分外,ASD患儿在其他部分及全量表的得分均与健康儿童的差异有统计学意义(P<0.01).结论 除口腔感觉处理和影响活动水平的运动的调节外,ASD患儿的各项感觉特征与健康发育儿童均存在一定差异.中文版儿童感觉剖析量表对区别ASD患儿与健康发育儿童有一定的鉴别力.     

Effortful control in typically developing boys and in boys with ADHD or autism spectrum disorder

Despite increased interest in the role of effortful control (EC) in developmental disorders, few studies have focused on EC in autism spectrum disorders (ASD) and no study so far has directly compared children with ASD and children with ADHD. A first aim of this study was to investigate whether typically developing (TD) boys, boys with ADHD and boys with ASD can be differentiated based on EC levels. A second aim was to evaluate the relationship between EC and symptoms of ADHD and ASD. We assessed EC in 27 TD boys, 27 boys with ADHD and 27 boys with ASD (age 10-15) using different EC questionnaires. Clinical groups scored lower than the TD group on all EC total scales, but could only be differentiated from each other by means of self-reported persistence, impulsivity and activation control. Our data suggest that although EC is useful in differentiating TD boys from clinical groups, it is less efficient in distinguishing ADHD from ASD. Also, results suggest that EC plays a role in the manifestation of symptoms of both ADHD and ASD and that high levels of EC enable children to function more adequate in daily situations.