1. Ajram LA, Pereira AC, Durieux AMS, Velthius HE, Petrinovic MM, McAlonan GM. {{The contribution of [1H] magnetic resonance spectroscopy to the study of excitation-inhibition in autism}}. {Progress in neuro-psychopharmacology & biological psychiatry}. 2018; 89: 236-44.
Autism spectrum disorder (ASD) affects over 1:100 of the population and costs the UK more than pound32bn and the USA more than $175bn ( pound104bn) annually. Its core symptoms are social and communication difficulties, repetitive behaviours and sensory hyper- or hypo-sensitivities. A highly diverse phenotypic presentation likely reflects its etiological heterogeneity and makes finding treatment targets for ASD challenging. In addition, there are no means to identify biologically responsive individuals who may benefit from specific interventions. There is hope however, and in this review we consolidate how findings from magnetic resonance spectroscopy (MRS) add to the evidence that differences in the brain’s excitatory glutamate and inhibitory gamma-aminobutyric acid (GABA) balance may be both a key biomarker and a tractable treatment target in ASD.
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2. Bakian AV, Bilder DA, Korgenski EK, Bonkowsky JL. {{Autism Spectrum Disorder and Neonatal Serum Magnesium Levels in Preterm Infants}}. {Child neurology open}. 2018; 5: 2329048×18800566.
Premature birth is associated with increased risk of autism spectrum disorder. Antenatal maternal magnesium administration is known to reduce subsequent risk of cerebral palsy including among premature infants, suggesting a potentially broader neuroprotective role for magnesium. Our objective was to determine whether magnesium could be protective against autism spectrum disorders in premature infants. A cohort of 4855 preterm children was identified, magnesium levels from 24 to 48 hours of life recorded, and subsequent autism spectrum disorder status determined. Adjusted relative risk of autism spectrum disorder with each 1 mg/dL increase in neonatal magnesium level was 1.15 (95% confidence interval: 0.86-1.53). Analysis of variance indicated that magnesium levels varied by gestational age and maternal antenatal magnesium supplementation, but not autism spectrum disorder status (F1,4824 = 1.43, P = .23). We found that neonatal magnesium levels were not associated with decreased autism spectrum disorder risk. Future research into autism spectrum disorder risks and treatments in premature infants is needed.
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3. Chen H, Uddin LQ, Guo X, Wang J, Wang R, Wang X, Duan X, Chen H. {{Parsing brain structural heterogeneity in males with autism spectrum disorder reveals distinct clinical subtypes}}. {Human brain mapping}. 2018.
Autism spectrum disorder (ASD) is a neurodevelopmental disorder with considerable neuroanatomical heterogeneity. Thus, how and to what extent the brains of individuals with ASD differ from each other is still unclear. In this study, brain structural MRI data from 356 right-handed, male subjects with ASD and 403 right-handed male healthy controls were selected from the Autism Brain Image Data Exchange database (age range 5-35 years old). Voxel-based morphometry preprocessing steps were conducted to compute the gray matter volume maps for each subject. Individual neuroanatomical difference patterns for each ASD individual were calculated. A data-driven clustering method was next utilized to stratify individuals with ASD into several subtypes. Whole-brain functional connectivity and clinical severity were compared among individuals within the ASD subtypes identified. A searchlight analysis was applied to determine whether subtyping ASD could improve the classification accuracy between ASD and healthy controls. Three ASD subtypes with distinct neuroanatomical difference patterns were revealed. Different degrees of clinical severity and atypical brain functional connectivity patterns were observed among these three subtypes. By dividing ASD into three subtypes, the classification accuracy between subjects of two out of the three subtypes and healthy controls was improved. The current study confirms that ASD is not a disorder with a uniform neuroanatomical signature. Understanding neuroanatomical heterogeneity in ASD could help to explain divergent patterns of clinical severity and outcomes.
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4. Cooper K, Loades ME, Russell AJ. {{Adapting Psychological Therapies for Autism – Therapist Experience, Skills and Confidence}}. {Research in autism spectrum disorders}. 2018; 45: 43-50.
Background: Psychological interventions informed by cognitive behavioural theory have proven efficacy in treating mild-moderate anxiety and depression. They have been successfully adapted for autistic children and adults who experience disproportionately high rates of co-occurring emotional problems. There has been little research into the perspectives and experience of psychological therapists adapting cognitive behavioural therapy (CBT) as part of routine clinical practice. We surveyed therapist skills, experience and confidence in working psychologically with autistic people, in order to highlight gaps and needs, as well as strengths in terms of therapist skills when working with this group. Method: Fifty therapists attending a training event completed a survey about their experience of adapting CBT for autistic clients, alongside a measure of therapist confidence. Results: Almost all therapists reported making adaptations to CBT practice when working with autistic clients. Key challenges identified were rigidity in thinking and pacing sessions appropriately. Therapists were relatively confident about core engagement and assessment skills but reported less confidence in using their knowledge to help this group. Therapist confidence was not associated with years of practice or number of adaptations made, but was positively associated with level of therapy training received. Conclusions: This study highlights a need for training and ongoing supervision to increase therapist confidence in and ability to make appropriate adaptations to CBT treatment protocols for autistic people.
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5. Dellapiazza F. {{Links between sensory processing, adaptive behaviours, and attention in children with autism spectrum disorder: A systematic review}}. {Psychiatry research}. 2018; 270: 78-88.
Atypical sensory processing has been described in autism spectrum disorder. The goal of this systematic review is to investigate the links between sensory processing, adaptive behaviours, and attention skills in children with autism spectrum disorder. The PRISMA guidelines were followed and a search was conducted using electronic databases: Medline, PsychInfo and Eric. Among the 11 studies about sensory processing that were selected, 7 investigated the association with adaptive behaviours and 5 with attention. Atypical sensory processing was reported in 82% to 97% of the participants with ASD, depending on the study. This review found a significant impact of sensory abnormalities on adaptive behaviour. In addition, we found interrelations between sensory processing and attention skills. However, the current literature is too limited to definitively conclude the direction of these interactions and the theories concerning perceptive functioning are conflicting.
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6. Hayward DA, Fenerci C, Ristic J. {{An investigation of global-local processing bias in a large sample of typical individuals varying in autism traits}}. {Consciousness and cognition}. 2018; 65: 271-9.
Although individuals with an autism spectrum disorder display impaired function across several social and behavioral domains, they possess intact, and often superior visual processing abilities for local relative to global aspects of their visual environment. To address whether differences in visual processing similarly vary within typical individuals as a function of their level of social competence, using the Navon hierarchical figures task, here we examined the relationship between global-local visual processing style and the number of autism-like traits in a large sample of 434 typically developed persons. In line with the existing literature, our data indicated an overall global processing bias. However, this overall visual processing style did not vary with participants’ number of autism-like traits. These results suggest that the visual processing of Navon figures may be different in typical individuals vs. those with an autism spectrum disorder, with those differences potentially reflecting specific stimulus and task settings.
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7. Jachyra P, Anagnostou E, Knibbe TJ, Petta C, Cosgrove S, Chen L, Capano L, Moltisanti L, McPherson AC. {{« Girls don’t have big tummies »: The experiences of weight-related discussions for children with autism spectrum disorders}}. {Autism : the international journal of research and practice}. 2018: 1362361318793020.
Children with autism spectrum disorders appear to be at a higher risk of having obesity than their typically developing peers. Although it has been recommended that healthcare providers speak to children with autism spectrum disorders about the potential health risks of unhealthy weight, no previous research has explored how healthcare providers communicate with them about this topic. The purpose of this study was to explore children’s perspectives and experiences of discussing weight-related topics in healthcare consultations. Eight children were interviewed, and an interpretive phenomenological analysis informed the research approach and analysis of the data. Results indicated that weight-related discussions with healthcare providers were often met with trepidation, anxiety, anger, and frustration. Children also expressed that they experienced weight stigma in clinical visits and everyday interactions. Weight stigma was often (unwittingly) projected by healthcare providers during appointments and had debilitating effects on children. Finally, higher weights emerged as a repetitive/restricted interest, and children reported body image challenges regarding their higher weights. Frameworks and tools that are specific to the needs and abilities of children with autism spectrum disorders are needed for healthcare providers to foster positive conversations about weight-related topics in an effort to promote lifelong wellness.
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8. Jun E, Kang E, Choi J, Suk HI. {{Modeling regional dynamics in low-frequency fluctuation and its application to Autism spectrum disorder diagnosis}}. {NeuroImage}. 2018.
With the advent of neuroimaging techniques, many studies in the literature have validated the use of resting-state fMRI (rs-fMRI) for understanding functional mechanisms of the brain, as well as for identifying brain disorders or diseases. One of the main streams in recent studies of modeling and analyzing rs-fMRI data is to account for the dynamic characteristics of a brain. In this study, we propose a novel method that directly models the regional temporal BOLD fluctuations in a stochastic manner and estimates the dynamic characteristics in the form of likelihoods. Specifically, we modeled temporal BOLD fluctuation of individual Regions Of Interest (ROIs) by means of Hidden Markov Models (HMMs), and then estimated the ‘goodness-of-fit’ of each ROI’s BOLD signals to the corresponding trained HMM in terms of a likelihood. Using estimated likelihoods of the ROIs over the whole brain as features, we built a classifier that can discriminate subjects with Autism Spectrum Disorder (ASD) from Typically Developing (TD) controls at an individual level. In order to interpret the trained HMMs and a classifier from a neuroscience perspective, we also conducted model analysis. First, we investigated the learned weight coefficients of a classifier by transforming them into activation patterns, from which we could identify the ROIs that are highly associated with ASD and TD groups. Second, we explored the characteristics of temporal BOLD signals in terms of functional networks by clustering them based on sequences of the hidden states decoded with the trained HMMs. We validated the effectiveness of the proposed method by achieving the state-of-the-art performance on the ABIDE dataset and observed insightful patterns related to ASD.
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9. Kentrou V, de Veld DM, Mataw KJ, Begeer S. {{Delayed autism spectrum disorder recognition in children and adolescents previously diagnosed with attention-deficit/hyperactivity disorder}}. {Autism : the international journal of research and practice}. 2018: 1362361318785171.
Phenotypic elements of autism spectrum disorder can be masked by attention-deficit/hyperactivity disorder symptoms, potentially leading to a misdiagnosis or delaying an autism spectrum disorder diagnosis. This study explored differences in the age of autism spectrum disorder diagnosis between participants with previously diagnosed attention-deficit/hyperactivity disorder versus autism spectrum disorder-only respondents. Children and adolescents, but not adults, initially diagnosed with attention-deficit/hyperactivity disorder received an autism spectrum disorder diagnosis an average of 1.8 years later than autism spectrum disorder-only children, although the findings regarding the adult sample should be interpreted with caution. Gender differences were also explored, revealing that the delay in receiving an autism diagnosis was 1.5 years in boys and 2.6 years in girls with pre-existing attention-deficit/hyperactivity disorder, compared with boys and girls without prior attention-deficit/hyperactivity disorder. No significant gender differences were observed in the adult sample. We argue that overlapping symptoms between autism spectrum disorder and attention-deficit/hyperactivity disorder might delay a formal diagnosis of autism either by leading to a misdiagnosis of attention-deficit/hyperactivity disorder or by making it difficult to identify the presence of co-occurring autism spectrum disorder conditions once an initial diagnosis of attention-deficit/hyperactivity disorder has been obtained. Current findings highlight the need to recruit multidimensional and multidisciplinary screening procedures to assess for potential emerging autism spectrum disorder hallmarks in children and adolescents diagnosed or presenting with attention-deficit/hyperactivity disorder symptoms.
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10. Miller HL, Cacola PM, Sherrod GM, Patterson RM, Bugnariu NL. {{Children with Autism Spectrum Disorder, Developmental Coordination Disorder, and typical development differ in characteristics of dynamic postural control: A preliminary study}}. {Gait & posture}. 2018; 67: 9-11.
BACKGROUND: Autism Spectrum Disorder (ASD) and Developmental Coordination Disorder (DCD) are developmental disorders with distinct definitions and symptoms. However, both conditions share difficulties with motor skills, including impairments in postural control. While studies have explored postural sway variables in children with DCD and ASD as compared to typical development (TD), few have used kinematic data to assess the magnitude of differences between these two neurodevelopmental conditions. There are few sensitive and specific measures available to assess balance impairment severity in these populations. RESEARCH QUESTION: Do individuals with ASD, DCD, and TD differ in dynamic postural control? METHODS: We quantified postural control differences between ASD, DCD, and TD during a dynamic balance task. 10 ASD, 10 DCD, and 8 TD agematched children completed a dynamic postural control task in a virtual environment. They leaned to shift their center of pressure (CoP) to match a user-controlled object to an oscillating target (0.1 Hz-0.8 Hz). RESULTS: The DCD group had higher CoP accelerations compared to ASD or TD. While the DCD and TD groups did not differ in their medial-lateral velocity, the ASD group had low medial-lateral velocity and acceleration as compared to DCD and TD. ASD group velocity and acceleration did not differ from that of the TD group in the anterior-posterior direction. Higher accelerations in the DCD group reflected non-fluid movements; by contrast, the ASD group had slower, more fluid movements. Results may reflect differences in how children with ASD and DCD plan, execute, and modify motor actions. SIGNIFICANCE: This study demonstrates the potential utility of CoP acceleration and velocity as a sensitive and specific means of differentiating between ASD, DCD, and TD. Results indicating group differences between ASD and DCD in velocity and acceleration profiles represent an important step toward understanding how these populations modify motor plans during dynamic tasks.
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11. Mughal S, Saadabadi A. Autism Spectrum Disorder (Regressive Autism, Child Disintegrative Disorder). StatPearls. Treasure Island (FL): StatPearls Publishing
StatPearls Publishing LLC.; 2018.
12. Murray LE, O’Neill L. {{Neuroticism and extraversion mediate the relationship between having a sibling with developmental disabilities and anxiety and depression symptoms}}. {Journal of affective disorders}. 2018; 243: 232-40.
Background Children growing up with a sibling with disabilities report higher levels of depression and anxiety symptoms as adults. Here, we examined whether personality characteristics also play a part in mediating this relationship. Method We tested for differences in personality traits between 132 individuals who have a sibling with developmental disabilities and 132 closely matched comparisons. Results Differences in Big Five factors of personality were demonstrated across the disability groups and between the disability groups and the comparisons, especially in Extraversion, Neuroticism and Openness. Individuals growing up alongside a sibling with developmental disabilities have a higher tendency to experience anxiety and depression symptoms, and this research is the first demonstration that personality traits mediate this relationship. Specifically, Neuroticism is a strong mediator of anxiety while both Neuroticism and Extraversion contribute mediating effects toward the development of depression. Limitations Our study made use of self-report methodology which, although having recognized limitations, is more reliable than parental reports. Given the cross-sectional nature of our design, we were not able to examine pre-existing developmental factors that may have influenced the participant’s propensity to particular personality traits and affective disorders. However, we obtained a large sample and closely matched participants to examine differences between those with a sibling with disabilities and those without. Conclusions As such, differences in personality traits have important implications for the understanding and treatment of siblings presenting with anxiety and depression symptoms. We recommend that intervention should target those high in Neuroticism among individuals who have a sibling with disabilities, and that more social support is put in place for siblings to mitigate their tendency towards introversion and buffer them against psychological maladjustment.
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13. Raghavan R, Zuckerman B, Hong X, Wang G, Ji Y, Paige D, DiBari J, Zhang C, Fallin MD, Wang X. {{Fetal and Infancy Growth Pattern, Cord and Early Childhood Plasma Leptin, and Development of Autism Spectrum Disorder in the Boston Birth Cohort}}. {Autism research : official journal of the International Society for Autism Research}. 2018.
Leptin is a proinflammatory cytokine that plays an important role in energy homeostasis. Emerging evidence suggests that leptin levels are altered in children with autism spectrum disorder (ASD); however, this has not been studied prospectively. Rapid growth during infancy and early childhood has been implicated in ASD, but the evidence is inconsistent. As leptin is involved in growth and is a potential risk factor for ASD, we explored the associations between (a) cord, early childhood leptin and ASD; and (b) birth weight for gestational age, early childhood weight gain, and ASD. We also assessed the mediating role of leptin in the relationship between weight gain during infancy and ASD. This study was conducted in a sample of 822 subjects from the Boston Birth Cohort. ASD was defined from diagnostic codes in electronic medical records. Extremely rapid weight gain during infancy was associated with a greater ASD risk and this persisted after adjusting for potential confounders (aOR: 3.11; 95% CI: 1.37, 7.07). Similarly, children that had higher plasma leptin levels, prior to ASD diagnosis, had an increased ASD risk in both unadjusted and adjusted models (aOR: 7.87; 95% CI: 2.06, 30.04). Further, early childhood leptin indirectly mediated the relationship between rapid weight gain and ASD. No associations were found between birth weight for gestational age, cord leptin and risk of ASD. Our findings provide a basis to further explore whether the combination of early life growth pattern and a biomarker such as leptin can predict ASD earlier. LAY SUMMARY: Is early life growth and a biomarker leptin related to ASD risk? To answer this question, we followed 822 children from birth and found that those who gained weight very quickly in infancy, had higher leptin levels in early childhood, had a greater chance of later ASD diagnosis. More research is needed to see if infant’s weight gain pattern along with a biomarker (such as leptin) can be used to identify children with ASD sooner.
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14. Schulz SE, Stevenson RA. {{Sensory hypersensitivity predicts repetitive behaviours in autistic and typically-developing children}}. {Autism : the international journal of research and practice}. 2018: 1362361318774559.
The objective of this study was to examine the relationship between sensory hypersensitivity and restricted interests and repetitive behaviours associated with autism spectrum disorder and their typically-developing peers. Furthermore, the aims included the examination of the relationship across sensory modalities and various types of restricted interests and repetitive behaviours. Data were collected from the parents of 114 children: 49 of whom were diagnosed with autism spectrum disorder and 65 typically-developing children. Parents completed the Sensory Profile 2 – Child Version and the Repetitive Behaviours Questionnaire, Second Edition. The results suggested that sensory hypersensitivity is strongly related to the core autism spectrum disorder symptom of repetitive behaviours. This relationship was not specific to autism spectrum disorder; repetitive behaviours significantly increased with sensory hypersensitivity in typically-developing individuals as well. This effect was consistent across all modalities in both autism spectrum disorder and typically developing groups; group differences were observed in the oral and tactile modalities. Furthermore, sensory hypersensitivity was significantly predictive of repetitive behaviours in all participants, autism spectrum disorder and typically-developing, and importantly, autism spectrum disorder diagnosis did not add any predictive influence above and beyond sensory hypersensitivity. Finally, sensory hypersensitivity was significantly predictive of all subdomains of repetitive behaviours, including repetitive motor movements, rigidity and adherence to routine, preoccupation with restricted patterns of interest and unusual sensory interests, and diagnosis added no predictive ability beyond sensory hypersensitivity.
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15. Syu YC, Lin LY. {{Sensory Overresponsivity, Loneliness, and Anxiety in Taiwanese Adults with Autism Spectrum Disorder}}. {Occupational therapy international}. 2018; 2018: 9165978.
Purpose: Sensory overresponsiveness is highly prevalent in individuals with autism spectrum disorders (ASD) and typically persist into adulthood. However, the role of sensory processing difficulties in influencing emotional well-being among adults with ASD remains unclear. Additionally, the associations between sensory overresponsiveness, anxiety, and loneliness are yet to be examined among adults with ASD. Therefore, to address these critical gaps in the literature, we aimed to investigate the relationships among sensory avoiding, anxiety, and loneliness in a sample of adults with ASD. Participants: Seventy adults (age, 20-39 years) completed three self-reported measures. All participants had a documented diagnosis of ASD and had normal IQ. Methods: Sensory processing, loneliness, and anxiety were assessed with the Adult Sensory Profile, short-form UCLA loneliness scale, and Beck Anxiety Inventory, respectively. Results: Autism spectrum traits and sensory avoiding were associated with anxiety and loneliness. Participants who experienced sensory avoiding more frequently reported higher anxiety and feelings of loneliness, with loneliness mediating the relationship between sensory avoiding and anxiety. More anxiety symptoms in participants with greater sensory avoiding were associated with their higher level of loneliness. Conclusion: This study demonstrates that the relationships existed between sensory processing difficulties, loneliness, and anxiety among adults with ASD. Interventions regarding sensory processing difficulties and emotional well-being are substantial need for adults with ASD, and our results highlight the importance of sensory overresponsiveness and anxiety in evaluating and improving the psychological well-being of adults with ASD.
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16. Tsai HJ, Cebula K, Liang SH, Fletcher-Watson S. {{Siblings’ experiences of growing up with children with autism in Taiwan and the United Kingdom}}. {Research in developmental disabilities}. 2018; 83: 206-16.
BACKGROUND: A child’s diagnosis of autism impacts their whole family, in both positive and negative ways, that may be influenced by cultural beliefs. AIMS: We aimed to describe the experiences of mothers and typically-developing siblings of children with autism in two cultural contexts. METHODS: Fourteen mother-sibling dyads from Taiwan and the UK participated in semi-structured interviews. RESULTS: Whilst there were similarities in sibling experiences, a negative tone regarding the influence of autism was more evident in Taiwan, where families also cited societal judgement and cultural-specific expectations. In the UK, a more balanced tone was apparent: mothers emphasised educating and involving the siblings. It is speculated that UK siblings had a greater understanding of their parents’ stress, leading to more adaptive family dynamics. Various types of support service were mentioned in the UK, whereas the availability of social services and support appeared to be relatively limited in Taiwan. IMPLICATIONS: Our data suggest that cultural context may have a significant impact on the responses of the family members. This is mediated by both differences in attitudes and traditions, and availability of resources. Support for family members needs to be sensitive to such cultural differences, as well as recognising positive experiences.
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17. Wilson NJ, Lee HC, Vaz S, Vindin P, Cordier R. {{Scoping Review of the Driving Behaviour of and Driver Training Programs for People on the Autism Spectrum}}. {Behavioural neurology}. 2018; 2018: 6842306.
Gaining a driver’s licence represents increased independence and can lead to improved quality of life for individuals and their families. Learning to drive a motor vehicle and maintaining safe on-road skills are often more difficult for people on the autism spectrum. Many countries currently have no autism-specific licencing requirements for learner drivers, and there is a general lack of ASD-specific support and training packages for individuals, their families, and driving instructors. This review synthesises the peer-reviewed literature about the driving characteristics of drivers on the spectrum and driver training available for the cohort. The evidence in this review showed that individuals on the autism spectrum drive differently from their neurotypical counterparts. There are shortcomings in tactical skills of drivers on the autism spectrum, but the extent to which this affects their own safety or the safety of other road users is unclear. Tactical skills can be improved through training programs. There are few autism spectrum-specific learner training programs available. Development of an effective training program will benefit individuals on the spectrum to learn to drive, be independent, and be safe on the road.
