Symptoms of attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorder (ASD) often co-occur. The DSM-IV had specified that an ASD diagnosis is an exclusion criterion for ADHD, ...thereby limiting research of this common clinical co-occurrence. As neurodevelopmental disorders, both ASD and ADHD share some phenotypic similarities, but are characterized by distinct diagnostic criteria. The present review will examine the frequency and implications of this clinical co-occurrence in children, with an emphasis on the available data regarding pre-school age. The review will highlight possible etiologies explaining it, and suggest future research directions necessary to enhance our understanding of both etiology and therapeutic interventions, in light of the new DSM-V criteria, allowing for a dual diagnosis.
Background: Structural language anomalies or impairments in autistic spectrum disorder (ASD) are theoretically and practically important, although underrecognised as such. This review aims to ...highlight the ubiquitousness of structural language anomalies and impairments in ASD, and to stimulate investigation of their immediate causes and implications for intervention.
Method: Studies of structural language in ASD are reviewed (based on a search of the literature and selected as meeting defined inclusion criteria), and explanatory hypotheses are discussed.
Results: Some individuals with ASD never acquire language. Amongst those who do, language abilities range from clinically normal (ALN) to various degrees of impairment (ALI). Developmental trajectories and individual profiles are diverse, and minority subgroups have been identified. Specifically: language is commonly but not always delayed and delayed early language is always characterised by impaired comprehension and odd utterances, and sometimes by deviant articulation and grammar. Nevertheless, by school age an ‘ASD‐typical’ language profile emerges from group studies, with articulation and syntax least affected, and comprehension, semantics and certain facets of morphology most affected. Thus, even individuals with ALN have poor comprehension relative to expressive language; also semantic‐processing anomalies and idiosyncratic word usage. It is argued that impaired socio‐emotional‐communicative relating, atypical sensory‐perceptual processing, and uneven memory/learning abilities may underlie shared language anomalies across the spectrum; and that varying combinations of low nonverbal intelligence, semantic memory impairment and comorbidities including specific language impairment (SLI), hearing impairment, and certain medical syndromes underlie ALI and variation in individual profiles.
Conclusions: Structural language is universally affected in ASD, due to a complex of shared and unshared causal factors. There is an urgent need for more research especially into the characteristics and causes of clinically significant language impairments.
Several studies support currently the hypothesis that autism etiology is based on a polygenic and epistatic model. However, despite advances in epidemiological, molecular and clinical genetics, the ...genetic risk factors remain difficult to identify, with the exception of a few chromosomal disorders and several single gene disorders associated with an increased risk for autism. Furthermore, several studies suggest a role of environmental factors in autism spectrum disorders (ASD). First, arguments for a genetic contribution to autism, based on updated family and twin studies, are examined. Second, a review of possible prenatal, perinatal, and postnatal environmental risk factors for ASD are presented. Then, the hypotheses are discussed concerning the underlying mechanisms related to a role of environmental factors in the development of ASD in association with genetic factors. In particular, epigenetics as a candidate biological mechanism for gene × environment interactions is considered and the possible role of epigenetic mechanisms reported in genetic disorders associated with ASD is discussed. Furthermore, the example of in utero exposure to valproate provides a good illustration of epigenetic mechanisms involved in ASD and innovative therapeutic strategies. Epigenetic remodeling by environmental factors opens new perspectives for a better understanding, prevention, and early therapeutic intervention of ASD.
Autism spectrum disorders (ASDs) are persistent disabling neurodevelopmental disorders clinically evident from early childhood. For the first time, the burden of ASDs has been estimated for the ...Global Burden of Disease Study 2010 (GBD 2010). The aims of this study were to develop global and regional prevalence models and estimate the global burden of disease of ASDs.
A systematic review was conducted for epidemiological data (prevalence, incidence, remission and mortality risk) of autistic disorder and other ASDs. Data were pooled using a Bayesian meta-regression approach while adjusting for between-study variance to derive prevalence models. Burden was calculated in terms of years lived with disability (YLDs) and disability-adjusted life-years (DALYs), which are reported here by world region for 1990 and 2010.
In 2010 there were an estimated 52 million cases of ASDs, equating to a prevalence of 7.6 per 1000 or one in 132 persons. After accounting for methodological variations, there was no clear evidence of a change in prevalence for autistic disorder or other ASDs between 1990 and 2010. Worldwide, there was little regional variation in the prevalence of ASDs. Globally, autistic disorders accounted for more than 58 DALYs per 100 000 population and other ASDs accounted for 53 DALYs per 100 000.
ASDs account for substantial health loss across the lifespan. Understanding the burden of ASDs is essential for effective policy making. An accurate epidemiological description of ASDs is needed to inform public health policy and to plan for education, housing and financial support services.
Autism spectrum disorder is characterized by patterns of delay and deviance in the development of social, communicative, and cognitive skills that arise in the first years of life. Although ...frequently associated with intellectual disability, this condition is distinctive in its course, impact, and treatment. Autism spectrum disorder has a wide range of syndrome expression and its management presents particular challenges for clinicians. Individuals with an autism spectrum disorder can present for clinical care at any point in development. The multiple developmental and behavioral problems associated with this condition necessitate multidisciplinary care, coordination of services, and advocacy for individuals and their families. Early, sustained intervention and the use of multiple treatment modalities are indicated.
The Autism Observation Scale for Infants (AOSI) was developed to detect and monitor early signs of autism as they emerge in high-risk infants (all with an older sibling with an autistic spectrum ...disorder). Here we describe the scale and its development, and provide preliminary data on its reliability. Inter-rater reliability both for total scores and total number of endorsed items is good to excellent at 6, 12 and 18 months; reliability is more modest for individual items, particularly in 6-month-olds. Test-retest reliability of the AOSI at 12 months of age is within acceptable limits. Evidence that the AOSI provides reliable data is the first critical step towards evaluating its efficacy in distinguishing high-risk infants who develop ASD.
Autism spectrum disorder (ASD) is associated with amplified emotional responses and poor emotional control, but little is known about the underlying mechanisms. This article provides a conceptual and ...methodologic framework for understanding compromised emotion regulation (ER) in ASD.
After defining ER and related constructs, methods to study ER were reviewed with special consideration on how to apply these approaches to ASD. Against the backdrop of cognitive characteristics in ASD and existing ER theories, available research was examined to identify likely contributors to emotional dysregulation in ASD.
Little is currently known about ER in youth with ASD. Some mechanisms that contribute to poor ER in ASD may be shared with other clinical populations (e.g., physiologic arousal, degree of negative and positive affect, alterations in the amygdala and prefrontal cortex), whereas other mechanisms may be more unique to ASD (e.g., differences in information processing/perception, cognitive factors e.g., rigidity, less goal-directed behavior and more disorganized emotion in ASD).
Although assignment of concomitant psychiatric diagnoses is warranted in some cases, poor ER may be inherent in ASD and may provide a more parsimonious conceptualization for the many associated socioemotional and behavioral problems in this population. Further study of ER in youth with ASD may identify meaningful subgroups of patients and lead to more effective individualized treatments.
Attention deficit disorder is a frequently observed symptom in individuals with autism spectrum disorder (ASD). This condition can present significant obstacles for those affected, manifesting in ...challenges such as sustained focus, task completion, and the management of distractions. These issues can impede learning, social interactions, and daily functioning. This complexity of symptoms underscores the need for tailored approaches in both educational and therapeutic settings to support individuals with ASD effectively. In this study, we have expanded upon our initial virtual reality (VR) prototype, originally created for attention therapy, to conduct a detailed statistical analysis. Our objective was to precisely identify and measure any significant differences in attention-related outcomes between sessions and groups. Our study found that heart rate (HR) and electrodermal activity (EDA) were more responsive to attention shifts than temperature. The ‘Noise’ and ‘Score’ strategies significantly affected eye openness, with the ASD group showing more responsiveness. The control group had smaller pupil sizes, and the ASD group’s pupil size increased notably when switching strategies in Session 1. Distraction log data showed that both ‘Noise’ and ‘Object Opacity’ strategies influenced attention patterns, with the ‘Red Vignette’ strategy showing a significant effect only in the ASD group. The responsiveness of HR and EDA to attention shifts and the changes in pupil size could serve as valuable physiological markers to monitor and guide these interventions. These findings further support evidence that VR has positive implications for helping those with ASD, allowing for more tailored personalized interventions with meaningful impact.
•Heart Rate and Electrodermal Activity showed more sensitivity to attention shifts.•In the Eye data analysis, the ASD group showed heightened eye openness with Object Opacity and Red Vignette strategies, indicating more attentional focus.•In the Distraction Log analysis, the ‘Noise’ and ‘Object Opacity’ strategies significantly affected attention patterns in both groups across both sessions.•The ‘Red Vignette’ strategy demonstrated a significant difference in the ASD group’s attention patterns between the two sessions, as revealed in the Distraction Log data.
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