Autism and family psychopathology: A Neuroprotective Effect?

An autism endophenotype may be identified on the basis of family psychopathology, but not in the direction you may think.

A review of: Lajiness-O’Neill, R., Menard, P. (2007). Brief Report: An Autistic Spectrum Subtype Revealed Through Familial Psychopathology Coupled with Cognition in ASD. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-007-0464-3

A genotype refers to a specific genetic profile. A phenotype refers to the presentation (behaviors, physical features, etc) of a genotype. An endophenotype refers to specific characteristics (biological, social, cultural, etc, etc) that may influence the expression of a disorder-related genotype. In this very interesting study the researchers examined parental psychiatric history and the neurocognitive functioning of 24 kids with Autism Spectrum Disorders (5 Autism, 7 Asperger’s, 12 PDD NOS; average age 9.16) and 49 children with learning disability but not autism. Autism diagnosis was based on DSM-IV criteria via CARS and ADI-R. The researchers found a significant higher rate of mood disorders and anxiety on the maternal side of children with ASD as compared to children with LD. There was a significant higher rate of learning disabilities and ADHD in the paternal side of children with ASD as compared to children with LD. A surprising finding was noted: Children with ASD who had a history of mood disorders in the maternal side (n=9), demonstrated significantly higher visuospatial functioning when compared to children with ASD who did not have a maternal history of mood disorders (n=14). The authors reported that this is consistent with a different study that found maternal mood disorders to be associated with elevated cognitive and adaptive functioning in children with ASD (Cohen and Tsiouris, 2006). Thus, although maternal mood disorders were more common in children with ASDs than in children with LDs, high rates of of these mood disorders seem to serve a neuroprotective function.

High Functioning Autism vs. Asperger’s: You say tomato I say tomahto

A review of:Kuusikko, S., Pollock-Wurman, R., Jussila, K., Carter, A.S., Mattila, M., Ebeling, H., Pauls, D.L., Moilanen, I. (2008). Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome. Journal of Autism and Developmental Disorders DOI: 10.1007/s10803-008-0555-9

When I first picked up this article I was excited because it seemed to directly address a clinical feature that some researchers and many clinicians have used to differentiate children with High Functioning Autism vs. Children with Asperger’s. We know that technically, based on DSM-IV diagnosis, the main difference between HFA and AS is the presence or absence of language delays. Kids with HFA, by definition, experience language delays, while kids with Asperger’s have typical language development. But in all clinical settings I have practiced, we have discussed other possible differences between these kids, specifically in regards to their neuropsychological profile and the nature of their limited social interaction with other peers. As for neuropsychological profile, HFA tend to have even verbal vs. non-verbal skills, while children with AS tend to have much higher verbal than non-verbal skills, consistent with the profile of children with “non-verbal learning disabilities”. In regards to their social interactions, in my clinical experience and interaction we colleagues, we see a difference in their ‘relative’ need for social companionship. In general children with HFA seem to just want to be by themselves without an explicit desire to interact with peers. They interact when necessary and when such interaction is functional, but not for the “intrinsic joy” of having social interactions. On the other hand, children with AS tend to desire close relationships with peers and explicitly talk about wanting more friends, but their social uniqueness make the establishing of such relation more difficult. Based on this last apparent clinical difference, you would expect that children with AS would experience more social anxiety due to a relative high need for social acceptance as compared to children with HFA. To test these hypotheses, a group in Finland compared 35 kids with AS, 21 kids with HFA (diagnosed via ADI and ADOS), and a large group of 353 typically developing kids of the same age (8-16 years old). The results were surprising: There was NO difference between the AS and the HFA in anxiety, social anxiety, social phobia, etc. As a group, the children with HFA/AS experienced higher level of anxiety and social phobia than the typically developing children. Furthermore, a developmental trajectory was observed. The anxiety problems tended to decrease with age in typically developing kids, but these problems increased with age in the children with HFA/AS. In summary, the data suggest that children with AS and HFA experience the same levels of social anxiety and phobias, which does not support the clinical view that these children may differ in regards to relative levels of social desirability.

Autism, Services, and Co-morbidity: Insights from Kansas. PART II

Title: Characteristics of children with autism spectrum disorders who received services through community mental health centers.
Authors: Stephanie A. Bryson, Susan K. Corrigan, Thomas P. Mcdonald, and Cheryl Holmes
Source: Autism 2008 12: 65-82. (January).

I apologize for the lack of posts since Friday. I was in Washington at a National Institutes of Health round table discussion on research in childhood-onset disorders. Although the meeting was focused on child depression, there are several issues that were debated that apply to Autism research and I will post some observations later this week.

This is the second part of my summary of the Kansas community mental health study. Please see the previous post for some background and basic description of the methodology. As you may remember, the authors compared children with autism to children with other ASD, all of whom had received services at community mental health centers in Kansas. The researchers explored differences in a variety of demographic factors but they were most interested in examining differences in rates of co-morbid disorders. Here are their basic findings: Children with PDD and Asperger’s, when compared to children with autism, had higher rates of co-morbid ADHD, Depressive Disorders, Oppositional Defiant Disorder, Bi-Polar Disorder, and Post Traumatic Stress Disorder. Children with Asperger’s and PDD were also more likely to have experienced a psychiatric hospitalization. Yet, children with Autism were more likely to receive special education services than children with other ASDs.

Brief Commentary: The authors discussed some possible interpretations of the data, and I want to reiterate one major point. At least 2 things may be at play here. It is possible that children with PDD and Asperger’s do in fact experience higher rates of these disorders. Some of the findings are consistent with our current understanding of ASDs. For example, some researchers have characterized the differences between Asperger’s and Autism (especially high functioning autism) to be mostly related to differences in social desirability. The basic premise is that children with Asperger’s HAVE a desire for social interactions and relationships with peers, but they have social limitations that make it difficult for them to develop such social interactions. One the other hand, children with autism are believed to lack an “explicit or apparent” desire to establish and maintain relationships with peers. This limited social desirability may actually be “protective” for depression and other disorders in children with Autism; while the apparent social affiliation needs of children with Asperger’s, coupled with their social limitations, may lead to higher levels of frustration and possibly more emotional distress. HOWEVER, the results may also be a byproduct of our clinical diagnostic practices. There are many reasons why clinicians may provide a co-morbid diagnosis. In my own clinical experience, most often a second diagnosis is provided only when such diagnosis serves a function that helps the child. For example, up to 70% of children with autism score in the mental retardation range of standard IQ tests, yet most kids with Autism do not receive a second diagnosis of Mental Retardation. Why? Because it serves no purpose (in addition to other theoretical consideration). However, I have seen children receive a second diagnosis of MR when such diagnosis served a purpose, such as allowing the family and child to receive extended services, insurance coverage, etc. Thus it is possible that the differences in diagnoses observed by the researchers are not differences in ACTUAL rates of the disorders but instead in the relevant utility of providing a co-morbid diagnosis to children with PDD, Asperger’s, and Autism.

Difficulty coping with changes may lead to anxiety in adults with Autism.

Title: Levels of anxiety and sources of stress in adults with autism.
Authors: Gillott, Alinda; Standen, P. J.
Source: Journal of Intellectual Disabilities. Vol 11(4) Dec 2007, 359-370.

Almost all research in autism is done with children, so it is always great to see new studies being conducted with adults. This study compared 34 adults with autism with 20 adults with intellectual impairment only. Although the two groups were equal in their intellectual abilities, adults with autism had much higher (3 times) levels of anxiety than adults with intellectual impairment but not autism. The factor that was most highly associated with stress for the adults with autism was their inability to cope with change. That is, those adults with autism who had most difficulty coping with change were also the adults who experienced the most anxiety. This has implications for treatment focus, specially for adults experiencing significant levels of anxiety. Specifically, adults with autism who experience anxiety may benefit from treatment interventions that address their ability to cope with changes.

Intellectual functioning at age six predicts internalizing and externalizing problems at age 9 in children with autism.

Title: Level of Intellectual Functioning Predicts Patterns of Associated Symptoms in School-Age Children With Autism Spectrum Disorder
Source: Journal on Mental Retardation. Vol 112(6) Nov 2007, 439-449.
Authors: Estes, Annette Mercer; Dawson, Geraldine; Sterling, Lindsey; Munson, Jeffrey.
University of Washington

A very innovative study from the University of Washington. They examined how intellectual functioning at age 6 predicted internalizing (depression and anxiety) and externalizing (conduct problems, adhd) behavior problems at age 9 in 57 children with autism. It appears that high verbal IQ at age 6 was actually associated with HIGHER levels of depression and anxiety at age 9, but non-verbal IQ was not associated with internalizing problems. However, lower verbal and non-verbal IQ was associated with HIGHER externalizing problems at age 9, specially ADHD. What is surprising about this study is that high verbal IQ was related to elevated levels of depression at age 9. A possible interpretation is that the high verbal intellectual skills of these kids paradoxically leads to a better understanding of their social limitations, specially rejections from peers, which may lead them to experience more anxiety and sadness.