Article

Relating ASD symptoms to well-being: Moving across different construct levels

September 2017
Psychological Medicine 48(7):1-14

DOI:10.1017/S0033291717002616

Authors:

Marie Deserno

Max Planck Institute for Human Development

Denny Borsboom

University of Amsterdam

Sander Begeer

Vrije Universiteit Amsterdam

Background Little is known about the specific factors that contribute to the well-being (WB) of individuals with autism spectrum disorder (ASD). A plausible hypothesis is that ASD symptomatology has a direct negative effect on WB. In the current study, the emerging tools of network analysis allow to explore the functional interdependencies between specific symptoms of ASD and domains of WB in a multivariate framework. We illustrate how studying both higher-order (total score) and lower-order (subscale) representations of ASD symptomatology can clarify the interrelations of factors relevant for domains of WB. Methods We estimated network structures on three different construct levels for ASD symptomatology, as assessed with the Adult Social Behavior Questionnaire (item, subscale, total score), relating them to daily functioning (DF) and subjective WB in 323 adult individuals with clinically identified ASD (aged 17–70 years). For these networks, we assessed the importance of specific factors in the network structure. Results When focusing on the highest representation level of ASD symptomatology (i.e. a total score), we found a negative connection between ASD symptom severity and domains of WB. However, zooming in on lower representation levels of ASD symptomatology revealed that this connection was mainly funnelled by ASD symptoms related to insistence on sameness and experiencing reduced contact and that those symptom scales, in turn, impact different domains of WB. Conclusions Zooming in across construct levels of ASD symptom severity into subscales of ASD symptoms can provide us with important insights into how specific domains of ASD symptoms relate to specific domains of DF and WB.

A Critical Review of Academic Literature Constructing Well-Being in Autistic Adults

Article

Full-text available

Feb 2021

Unlabelled: The emergence of critical autism studies has fueled efforts to interrogate how autistic people are studied and described in academic literature. While there is a call for research that promotes better well-being for autistic people, little attention has been paid to the concept of well-being itself. Just as the medical model limits critical understandings of autism in the academic literature, so too may psychological accounts of well-being limit, rather than expand, possibilities of living a good life for autistic people. The purpose of this critical review was to identify and critique how well-being in autistic adults is constructed in research. Based on a systematic search of peer-reviewed empirical research published from 2013 to 2020, we identified 63 articles that involved direct data collection with autistic adults and focused on well-being constructs such as quality of life, life satisfaction, and happiness. We examined the articles using the techniques of critical discourse analysis to discern assumptions underlying constructions of autistic well-being, with special attention to the axiological and teleological contributions of autistic perspectives in the research and writing processes. We identified several approaches through which the literature constructed autistic well-being: (1) well-being as an objective uncontested variable, (2) well-being as personal and not fixed, (3) well-being that warrants a specific measure for the autistic population, and (4) well-being as a situated account that privileges and centers autistic people's perspectives. We subject these accounts to critical analysis, pointing to how they limit and open life possibilities for autistic people. We recommend that researchers and practitioners critically reflect on how they engage autistic adults and use their input to create works that support well-being in ways that are meaningful and ethical to autistic adults, as well as do justice to changing broader narratives of autism in research and society. Lay summary: Why was this study done?: More autistic people and researchers have advocated to study autism in critical and positive ways. While it is important to promote better well-being for autistic people, little is known about what well-being actually means to them.What was the purpose of this study?: The purpose of our critical review was to identify how the concept of well-being in autistic people is understood and described in academic literature. We also critiqued how well-being research considers the input and perspectives of autistic adults.What did we do?: We systematically searched for research articles published between 2013 and 2020. We identified 63 articles that involved direct data collection with autistic adults and focused on well-being and related concepts such as quality of life, life satisfaction, and happiness. We analyzed the articles by focusing on how they used language to describe well-being in autistic adults and how they valued the data collected from these adults.What did we find?: We identified several ways that article authors described their understanding of autistic well-being: (1) well-being as an objective and uncontested object, (2) well-being is personal and can vary in nature, (3) well-being warrants a measure that considers opinions of autistic people, and (4) well-being as very specific to autistic people's subjective perspectives. We critically analyzed how these different understandings limit or open life possibilities for autistic people's well-being.How will this work help autistic people?: We recommend that researchers critically reflect on how they engage autistic adults and use their input in research. Promoting well-being needs to be meaningful and ethical to autistic adults. Research also needs to advocate for social justice to challenge how the majority in society understands or misunderstands autistic people.

Highways to happiness for autistic adults? Perceived causal relations among clinicians

Article

Full-text available

Dec 2020
PLOS ONE

The network approach to psychological phenomena advances our understanding of the interrelations between autism and well-being. We use the Perceived Causal Relations methodology in order to (i) identify perceived causal pathways in the well-being system, (ii) validate networks based on self-report data, and (iii) quantify and integrate clinical expertise in autism research. Trained clinicians served as raters (N = 29) completing 374 cause-effects ratings of 34 variables on well-being and symptomatology. A subgroup (N = 16) of raters chose intervention targets in the resulting network which we found to match the respective centrality of nodes. Clinicians’ perception of causal relations was similar to the interrelatedness found in self-reported client data (N = 323). We present a useful tool for translating clinical expertise into quantitative information enabling future research to integrate this in scientific studies.

Examining the special interest areas of autistic adults with a focus on their employment and mental health outcomes

Article

Oct 2022

BACKGROUND: Many individuals with autism spectrum disorder (ASD) have special interest areas (SIAs) which are characterized by significant depth and breadth of knowledge in a particular topic. These interests can continue through adulthood. OBJECTIVE: We conducted this study to develop a better understanding of the relation between SIAs and employment and mental health outcomes of adults with ASD. METHODS: Qualitative and quantitative analyses were used to examine the data with an emphasis on bringing autistic voices to the forefront of the discussion. Seventy-two adults with ASD, ages 18–53, completed an online survey describing their SIA engagement, employment status, and current mental health measured by two standardized assessments. Respondents provided open-ended responses describing their SIA and beliefs regarding SIAs broadly. RESULTS: Open-ended responses indicated adults with ASD have highly diverse SIAs that are rarely utilized in their employment experiences. Hierarchical regressions revealed SIA-related bullying was associated with higher levels of depression, anxiety, and stress. SIA employment was associated with depression such that those who were not currently employed in their SIA reported higher levels of depression. Respondents without support from people in their life related to their SIA reported higher levels of stress. CONCLUSION: SIAs are extremely important in the lives of autistic adults and should be utilized to enhance their employment experiences and overall well-being. Family members, adult service providers, and educational professionals should support and encourage SIAs.

Autistic Symptoms, Irritability, and Executive Dysfunctions: Symptom Dynamics from Multi-Network Models

Article

Full-text available

Jul 2023
J AUTISM DEV DISORD

Socio-cognitive difficulties in individuals with autism spectrum disorder (ASD) are heterogenuous and often co-occur with irritability symptoms, such as angry/grouchy mood and temper outbursts. However, the specific relations between individual symptoms are not well-represented in conventional methods analyzing aggregated autistic symptoms and ASD diagnosis. Moreover, the cognitive-behavioral mechanisms linking ASD to irritability are largely unknown. This study investigated the dynamics between autistic (Social Responsiveness Scale) and irritability (Affective Reactivity Index) symptoms and executive functions (Cambridge Neuropsychological Test Automated Battery) in a sample of children and adolescents with ASD, their unaffected siblings, and neurotypical peers (N = 345, aged 6–18 years, 78.6% male). Three complementary networks across the entire sample were computed: (1) Gaussian graphical network estimating the conditional correlations between symptom nodes; (2) Relative importance network computing relative influence between symptoms; (3) Bayesian directed acyclic graph estimating predictive directionality between symptoms. Networks revealed numerous partial correlations within autistic (rs = .07–.56) and irritability (rs = .01–.45) symptoms and executive functions (rs = −.83 to .67) but weak connections between clusters. This segregated pattern converged in all directed and supplementary networks. Plausible predictive paths were found between social communication difficulties to autism mannerisms and between “angry frequently” to “lose temper easily.” Autistic and irritability symptoms are two relatively independent families of symptoms. It is unlikely that executive dysfunctions explain elevated irritability in ASD. Findings underscore the need for researching other mood and cognitive-behavioral bridge symptoms, which may inform individualized treatments for co-occurring irritability in ASD.

Mental health and environmental factors in adults: A population-based network analysis

Article

Jul 2023
AM PSYCHOL

Few studies have assessed the multifactorial nature of environmental influences on population mental health. In this large-scale, population-based study of adults, we applied network analysis to study the relationship between environmental factors and symptoms of depression, anxiety, and well-being. We estimated networks with overall mental health nodes and individual symptoms to assess both broad and fine-grained associations between environmental factors and mental health. Finally, we conducted an out-of-sample replication in an independent large-scale sample to assess the robustness of our results. Across 31,000 adults randomly sampled from the Norwegian population, we identified associations between numerous environmental characteristics and mental health. Recent discrimination and unsupportive social environments were strongly associated with lower population well-being and higher levels of mental illness symptoms, respectively. The most strongly connected variables in the networks were environmental factors, including perceived problems with crime, violence, or vandalism in the residential area, worrying about violence or threats when outside, and problems with noise or contamination at home. Substantial variation in population mental health was explained by environmental factors included in the networks. Replicability of the results was excellent and suggestive of strong robustness of the results across samples. Our findings are indicative of the importance of environmental factors, such as the social environment, housing satisfaction, and residential area characteristics, for multiple aspects of population mental health. We identify several environmental factors that represent potentially useful targets for future studies and public health efforts seeking to improve mental health in the general population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Functioning and quality of life in transition-aged youth on the autism spectrum – associations with autism symptom severity and mental health problems

Article

Full-text available

Jun 2023
RES AUTISM SPECT DIS

Previous research notes difficulties in functioning and low quality of life (QoL) among transition-age youth on the autism spectrum, and poor mental health may contribute to these difficulties. This study examined the role of autism symptom severity and mental health problems on self-reported functioning and QoL in treatment-seeking transition-age autistic youth. The study included 140 autistic youth (16–25 years, M = 20.44 (SD = 2.95); n = 91 females [65%], n = 42 males 30%], n = 7 non-binary [5%]). We assessed functioning using a structured interview and QoL through a self-report questionnaire. Factors potentially associated with functioning and QoL were assessed using standardized self-report questionnaires of autism symptom severity, symptoms of anxiety and depression, and information from medical records. Participants reported functioning on the 90th percentile compared to general population norms, indicating significant disability, and also rated low overall QoL. Regression analysis showed that autism symptom severity and anxiety symptoms, and to some extent gender and having an ADHD diagnosis, explained 46% of the variance in overall functioning. Symptoms of anxiety and depression, and to a lesser extent, active friendship, explained 43% of the variance in QoL. Sampling limitations of the study include the overrepresentation of women and newly diagnosed participants. We highlight that functioning and QoL are multifactorial, necessitating a comprehensive assessment of transition-aged autistic youth, including mental health problems, to plan tangible interventions.

Crossing the Threshold: An Epigenetic Alternative to Dimensional Accounts of Mental Disorders

Article

Full-text available

Apr 2023
BRIT J PHILOS SCI

Recent trends in psychiatry involve a transition from categorical to dimensional frameworks, in which the boundary between health and pathology is understood as a difference in degree rather than as a difference in kind. A major tenet of dimensional approaches is that no qualitative distinction can be made between health and pathology. As a consequence, these approaches tend to characterize such a threshold as pragmatic or conventional in nature. However, dimensional approaches to psychopathology raise several epistemological and ontological issues. First, we review major sources of evidence usually recruited in support of the dimensional trend (focusing on clinical observation and biological data), and we show that these are connected to different conceptualizations of how dimensional traits extend across health and pathology. Second, we criticize two unquestioned assumptions that stand at the core of the dimensional trend: a) that there is continuity from health to pathology at the symptomatic level; b) that such continuity reflects an underlying continuity in the genetic liability for pathological conditions. Third, we argue against the idea of a conventional threshold by showing that such a view implies a linear relationship between the genotype and the phenotype. Fourth, drawing on epigenetics and developmental biology, we offer a characterization of mental disorders as stable and dynamic constellations of multi-level variables that differ qualitatively from ‘healthy states’. We conclude by showing that our account has several theoretical advantages over both categorical and dimensional approaches. Notably, it provides crucial insights into psychological development over time and individual differences, with major implications in terms of intervention and clinical decision-making.

Mental health and environmental factors in adults: A population-based network analysis

Preprint

Full-text available

Jan 2023

Few studies have assessed the multifactorial nature of environmental influences on population mental health. In this large-scale, population-based study of adults, we applied network analysis to study the relationship between environmental factors and symptoms of depression, anxiety, and wellbeing. We estimated networks with overall mental health nodes and individual symptoms to assess both broad- and fine-grained associations between environmental factors and mental health. Finally, we conducted an out-of-sample replication in an independent large-scale sample to assess the robustness of our results. Across 31,000 adults randomly sampled from the Norwegian population, we found evidence of key associations between environmental characteristics and mental health. Recent discrimination and unsupportive social environments were strongly associated with lower population wellbeing and higher levels of mental illness symptoms, respectively. The most strongly connected variables in the networks were environmental factors, including perceived problems with crime, violence, or vandalism in the residential area, worrying about violence or threats when outside, and problems with noise or contamination at home. Substantial variation in population mental health was explained by environmental factors included in the networks. Replicability of the results was excellent and indicative of strong robustness of the results across samples. Our findings highlight the importance of environmental factors, such as the social environment, housing satisfaction, and residential area characteristics, for multiple aspects of population mental health. We identify several environmental factors which represent potentially useful targets for future studies and public health efforts seeking to improve mental health in the general population.

Using Network Models in Person-Centered Care in Psychiatry: How Perspectivism Could Help To Draw Boundaries

Article

Full-text available

Sep 2022

In this paper, we explore the conceptual problems that arise when using network analysis in person-centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that perspectival reasoning can make more explicit what questions personalized network models can address in PCC, given their boundaries.

Advancing research on early autism through an integrated risk and resilience perspective

Article

Full-text available

Apr 2022

To date, a deficit-oriented approach dominates autism spectrum disorder (ASD) research, including studies of infant siblings of children with ASD at high risk (HR) for the disabilities associated with this disorder. Despite scientific advances regarding early ASD-related risk, there remains little systematic investigation of positive development, limiting the scope of research and quite possibly a deeper understanding of pathways toward and away from ASD-related impairments. In this paper, we argue that integrating a resilience framework into early ASD research has the potential to enhance knowledge on prodromal course, phenotypic heterogeneity, and developmental processes of risk and adaptation. We delineate a developmental systems resilience framework with particular reference to HR infants. To illustrate the utility of a resilience perspective, we consider the “female protective effect” and other evidence of adaptation in the face of ASD-related risk. We suggest that a resilience framework invites focal questions about the nature, timing, levels, interactions, and mechanisms by which positive adaptation occurs in relation to risk and developmental pathways toward and away from ASD-related difficulties. We conclude with recommendations for future research, including more focus on adaptive development and multisystem processes, pathways away from disorder, and reconsideration of extant evidence within an integrated risk-and-resilience framework.

Intervening on psychopathology networks: Evaluating intervention targets through simulations

Article

Full-text available

Nov 2021
METHODS

Identifying the different influences of symptoms in dynamic psychopathology models may hold promise for increasing treatment efficacy in clinical applications. Dynamic psychopathology models study the behavioral patterns of symptom networks, where symptoms mutually enforce each other. Interventions could be tailored to specific symptoms that are most effective at lowering symptom activity or that hinder the further development of psychopathology. Simulating interventions in psychopathology network models fits in a novel tradition where symptom-specific perturbations are used as in silico interventions. Here, we present the NodeIdentifyR algorithm (NIRA) to identify the projected most efficient, symptom-specific intervention target in a network model (i.e., the Ising model). We implemented NIRA in a freely available R package. The technique studies the projected effects of symptom-specific interventions by simulating data while symptom parameters (i.e., thresholds) are systematically altered. The projected effect of these interventions is defined in terms of the expected change in overall symptom activity across simulations. With this algorithm, it is possible to study (1) whether symptoms differ in their projected influence on the behavior of the symptom network, and, if so, (2) which symptom has the largest projected effect in lowering or increasing overall symptom activation. As an illustration, we apply the algorithm to an empirical dataset containing Post-Traumatic Stress Disorder symptom assessments of participants who experienced the Wenchuan earthquake in 2008. The most important limitations of the method are discussed, as well as recommendations for future research, such as shifting towards modeling individual processes to validate these types of simulation-based intervention methods.

Intervening on psychopathology networks: Evaluating intervention targets through simulations

Preprint

Full-text available

Jul 2021

Identifying the different influences of symptoms in dynamic psychopathology models may hold promise for increasing treatment efficacy in clinical applications. Dynamic psychopathology models study the behavioral patterns of symptom networks, where symptoms mutually enforce each other. Interventions could be tailored to specific symptoms that are most effective at lowering symptom activity or that hinder the further development of psychopathology. Simulating interventions in psychopathology network models fits in a novel tradition where symptom-specific perturbations are used as in silico interventions. Here, we present the NodeIdentifyR algorithm (NIRA) to identify the projected most efficient, symptom-specific intervention target in the Ising model. This algorithm is implemented in a novel and freely available R package. The technique studies the projected effects of symptom-specific interventions by simulating data while symptom parameters (i.e., threshold parameters) are systematically altered. The projected effect of these interventions is defined in terms of the expected change in overall symptom activity across simulations. With this algorithm, it is possible to study (1) whether symptoms differ in their projected influence on the behavior of the symptom network, and, if so, (2) which symptom has the largest projected effect in lowering and increasing overall symptom activation. As an illustration, we apply the algorithm to an empirical dataset containing assessments of PTSD symptoms in a sample that experienced the Wenchuan earthquake in 2008. The most important limitations of the method are discussed, as well as recommendations for future research, such as shifting towards modeling individual processes to validate these types of simulation-based intervention methods.

Internet-Based Support and Coaching With Complementary Clinic Visits for Young People With Attention-Deficit/Hyperactivity Disorder and Autism: Controlled Feasibility Study

Article

Full-text available

Dec 2020
J MED INTERNET RES

Background Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can experience obstacles in traditional health care situations due to difficulties associated with their impairment. Objective This controlled study aims to investigate the feasibility of an internet-based support and coaching intervention (IBSC), including 2 weekly chat sessions and 2 complementary clinic visits with coaches over the course of 8 weeks, for adolescents and young adults with ADHD and/or ASD in 2 naturalistic routine care settings. Methods Individuals with ADHD and/or ASD aged 15-32 years were recruited in 2 clinical settings, where they received either IBSC (n=24) or treatment as usual (TAU; n=20). Outcome measures included self-report questionnaires assessing quality of life (Manchester Short Assessment for Quality of Life), sense of coherence (Sense Of Coherence 29), self-esteem (Rosenberg Self-Esteem Scale), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS] and Montgomery-Åsberg Depression Rating Scale-Self-reported, respectively). Results Significant between-group effects were observed in measures of anxiety (HADS) at postintervention (P=.02) as well as at the 6-month follow-up (P=.004). Significant between-group effects were also noted for depressive symptoms (HADS) postintervention (P=.04). The between-group effects were partially explained by a deterioration in the TAU group. A significant increase in self-esteem (P=.04) as well as a decrease in anxiety (P=.003) at the 6-month follow-up was observed in the intervention group following IBSC. Findings from a qualitative study of the intervention are consistent with the results. Conclusions The findings from this study suggest that IBSC holds promise as a feasible complement or alternative to traditional face-to-face health care meetings.

Internet-Based Support and Coaching With Complementary Clinic Visits for Young People With Attention-Deficit/Hyperactivity Disorder and Autism: Controlled Feasibility Study (Preprint)

Preprint

Full-text available

Apr 2020

BACKGROUND Individuals with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) can experience obstacles in traditional health care situations due to difficulties associated with their impairment. OBJECTIVE This controlled study aims to investigate the feasibility of an internet-based support and coaching intervention (IBSC), including 2 weekly chat sessions and 2 complementary clinic visits with coaches over the course of 8 weeks, for adolescents and young adults with ADHD and/or ASD in 2 naturalistic routine care settings. METHODS Individuals with ADHD and/or ASD aged 15-32 years were recruited in 2 clinical settings, where they received either IBSC (n=24) or treatment as usual (TAU; n=20). Outcome measures included self-report questionnaires assessing quality of life (Manchester Short Assessment for Quality of Life), sense of coherence (Sense Of Coherence 29), self-esteem (Rosenberg Self-Esteem Scale), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS] and Montgomery-Åsberg Depression Rating Scale-Self-reported, respectively). RESULTS Significant between-group effects were observed in measures of anxiety (HADS) at postintervention ( P =.02) as well as at the 6-month follow-up ( P =.004). Significant between-group effects were also noted for depressive symptoms (HADS) postintervention ( P =.04). The between-group effects were partially explained by a deterioration in the TAU group. A significant increase in self-esteem ( P =.04) as well as a decrease in anxiety ( P =.003) at the 6-month follow-up was observed in the intervention group following IBSC. Findings from a qualitative study of the intervention are consistent with the results. CONCLUSIONS The findings from this study suggest that IBSC holds promise as a feasible complement or alternative to traditional face-to-face health care meetings.

Repenser la comorbidité psychiatrique : Une revue conceptuelle sous l'angle de la comordibité anxio-dépressive

Article

Full-text available

Sep 2020

La question de la comorbidité (i.e., la présence conjointe de plusieurs troubles) n’est que très peu documentée dans la littérature scientifique actuelle. Pourtant, au vu des données épidémiologiques alarmantes et du coût sociétal qu’elle représente, elle est au cœur des enjeux tant cliniques que sociétaux. La comorbidité constitue un défi de taille pour les cliniciens, et à ce jour, aucun consensus clair n’existe quant à la manière de penser et d’intervenir sur la comorbidité psychiatrique. Sous l’angle de la comorbidité anxio-dépressive, cet article a pour objectif de présenter les différentes perspectives conceptuelles récentes de la comorbidité en parcourant un éventail des données épidémiologiques et de perspectives théoriques contemporaines. Les convergences et divergences entre ces différentes approches se rapportant à la comorbidité sont particulièrement examinées. Enfin, les nouvelles démarches et courants de recherche en rupture avec les approches catégorielles sont présentées. En outre, elles offrent aux praticiens de nouvelles pistes de réflexion et de conceptualisation de la comorbidité.

Repenser la comorbidité psychiatrique : Une revue conceptuelle sous l’angle de la comordibité anxio-dépressive

Preprint

Full-text available

Feb 2020

Repenser la comorbidité psychiatrique : Une revue conceptuelle sous l’angle de la comordibité anxio-dépressive

Preprint

Full-text available

Jul 2020

The Self‐Construal Scale: A Potential Tool for Predicting Subjective Well‐Being of Individuals With Autism Spectrum Disorder

Article

Dec 2019

Despite accumulating evidence that culture shapes the symptoms of autism spectrum disorder (ASD), no studies have yet applied the Self‐Construal Scale to individuals with ASD. We compared the self‐construals (measured using the Self‐Construal Scale) of 31 high‐functioning Japanese individuals with ASD with those of 60 typically developing (TD) individuals. We also examined how the self‐construals of individuals with ASD related to their intelligence quotient, adverse childhood experiences, attention deficit hyperactivity disorder, ASD symptoms during adulthood and preschool years, and subjective well‐being. Individuals with ASD were more likely to display independent self‐construals than were TD individuals; unexpectedly, however, a substantial proportion of individuals with ASD (43.8%) displayed relatively interdependent self‐construals. Among individuals with ASD, self‐construals were significantly associated with ASD symptoms during preschool years, and with satisfaction of the need for autonomy and frustration of the need for relatedness. Evaluating self‐construals can help predict the subjective well‐being of high‐functioning individuals with ASD. Moreover, the Self‐Construal Scale may be useful for understanding the heterogeneous phenotypes of ASD, based on its association with autistic symptoms during preschool years, suggesting that the scale is a potential tool to develop efficient interventions for high‐functioning individuals with ASD. Autism Res 2020, 13 : 947‐958. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Autism Spectrum Disorders (ASD) are a group of disorders presenting a variety of symptoms and biological origins that can complicate choosing an intervention best suited for improving well‐being. Results indicate that a self‐construal scale could help understand individuals with high‐functioning ASD by independent and interdependent self‐construals that are associated with ASD symptoms during preschool years and adult subjective well‐being. Our findings suggest that this scale can help understand ASD and select appropriate interventions.

Autism and depression are connected: A report of two complimentary network studies

Article

Full-text available

Nov 2019
AUTISM

Autism and depression often co-occur. Through network analysis, we seek to gain a better understanding of this co-occurrence by investigating whether (1) autism and depression share overlapping groups of symptoms and/or (2) are connected through a bridge of mastery or worry symptoms. This is addressed in two complimentary studies: (1) Study 1 focusing on depressed ( N = 258) and non-depressed adults ( N = 117), aged 60–90 years; (2) Study 2 focusing on autistic ( N = 173) and non-autistic adults ( N = 70), aged 31–89 years. Self-report questionnaire data were collected on autistic traits (AQ-28), depression symptoms (Study 1: Inventory of Depressive Symptomatology Self Report; Study 2: Symptom Checklist 90–Revised depression subscale), worry (Worry Scale-R) and mastery (the Pearlin Mastery Scale). For both studies, data were analysed by creating glasso networks and subsequent centrality analyses to identify the most influential variables in the respective networks. Both depressed and autistic adults are highly similar in the perceived amount of worries and lack of control. While caution is needed when interpreting the pattern of findings given the bootstrapping results, findings from both studies indicate that overlapping symptoms do not fully explain the co-occurrence of autism and depression and the perception of having control over your life, that is, mastery seems a relevant factor in connecting autism and depression.

Identification of Novel Inhibitor of Protein Tyrosine Phosphatases Delta: Structure-Based Pharmacophore Modeling, Virtual Screening, Flexible Docking, Molecular Dynamics Simulation, and Post-Molecular Dynamics Analysis

Article

Oct 2019

Owing to their unique functions in regulating the synapse activity of Protein Tyrosine Phosphatases Delta (PTPδ) that has drawn special attention for developing drugs to Autism Spectrum Disorders (ASDs). In this study, the PTPδ pharmacophore was first established by the structure based pharmacophore method. Subsequently, 10 compounds contented Lipinski’s rule of five was acquired by the virtual screening of the PTPδ pharmacophore against ZINC and PubChem databases. Then, the 10 identified molecules were discovered that had better binding affinity than a known PTPδ inhibitors compound SCHEMBL16375396. Two compounds SCHEMBL16375408 and ZINC19796658 with high binding score, low toxicity were gained. They were observed by docking analysis and molecular dynamics simulations that the novel potential inhibitors not only possessed the same function as SCHEMBL16375396 did in inhibiting PTPδ, but also had more favorable conformation to bind with the catalytic active regions. This study provides a new method for identify PTPδ inhibitor for the treatment of ASDs disease.

Latent Variable Models and Networks: Statistical Equivalence and Testability

Article

Full-text available

Oct 2019

Networks are gaining popularity as an alternative to latent variable models for representing psychological constructs. Whereas latent variable approaches introduce unobserved common causes to explain the relations among observed variables, network approaches posit direct causal relations between observed variables. While these approaches lead to radically different understandings of the psychological constructs of interest, recent articles have established mathematical equivalences that hold between network models and latent variable models. We argue that the fact that for any model from one class there is an equivalent model from the other class does not mean that both models are equally plausible accounts of the data-generating mechanism. In many cases the constraints that are meaningful in one framework translate to constraints in the equivalent model that lack a clear interpretation in the other framework. Finally, we discuss three diverging predictions for the relation between zero-order correlations and partial correlations implied by sparse network models and unidimensional factor models. We propose a test procedure that compares the likelihoods of these models in light of these diverging implications. We use an empirical example to illustrate our argument.

Autismus und soziale Interaktion im Alltag: neue Forschungswege [Autism and social interaction in everyday life: new research avenues]

Article

Apr 2018

Tobias Schuwerk

Beeinträchtigungen der sozialen Interaktion und Kommunikation charakterisieren Autismus-Spektrum-Störungen. Traditionelle Autismusforschung konzentrierte sich auf die Untersuchung der Ursachen und zugrundeliegenden Mechanismen dieser Veränderungen in gut kontrollierbaren Labor-Settings. Bisher gibt es jedoch nur wenig systematisches Wissen, wie veränderte soziale Interaktion und Kommunikation das Alltagsleben von Menschen mit Autismus beeinflussen. Auch gab es bisher wenig Möglichkeiten für Menschen mit Autismus, Forschungsprogramme aktiv mitzugestalten. Dieser Überblicksartikel fast den aktuellen Forschungsstand zu kognitiven Grundlagen sozialer Interaktion und Kommunikation bei Autismus mit einem Fokus auf methodische Schwierigkeiten zusammen. Anschließend werden neue Forschungswege, die sich diesen Herausforderungen stellen, vorgestellt. Kollaboration, der Aufbau von Datenbanken und die Untersuchung autistischer Persönlichkeitseigenschaften in der Gesamtbevölkerung ermöglichen Forschung an großen Stichproben. Methodische Neuerungen, wie smartphone-basierte Datenerhebung, erlauben es, soziale Interaktion und Kommunikation im Alltag präzise zu messen. Partizipation von Menschen mit Autismus und deren Familien fördert Forschung, die theoretisch bedeutsam und praktisch relevant für ein Alltagsleben mit Autismus ist.

Comparison of network structures between autistic and non-autistic adults, and autism subgroups: A focus on demographic, psychological, and lifestyle factors

Article

Sep 2023
AUTISM

Differences in (autism) characteristics are often reported between autistic and non-autistic adults but also between autistic adults. We aimed to determine whether mean differences correspond to differences in network structure of these characteristics in (1) autistic and non-autistic adults and (2) two previously identified autism subgroups. A total of 16 network variables related to demographic and psychological characteristics were included. First, Gaussian Graphical Models (GGMs) were used for network estimation in 261 autistic adults and 384 non-autistic comparisons aged 30–85 years. Second, we repeated this step within two previously identified autism subgroups ( N 1 = 124, N 2 = 130). Third, sex differences were explored in the networks of the autism subgroups. The networks of the autism and comparison groups differed on individual edges and visual inspection, although the Network Comparison Test (NCT) showed no overall differences. The networks of autism subgroups were similar based on visual inspection and statistical comparisons. Sex did not impact the subgroup networks differently. Networks were more similar than different, but observed edge differences could be informative for targeted support. Focusing on mean differences is not sufficient to determine which factors (and associations) are important for autistic people. Thus, network analysis provides a valuable tool beyond assessing mean differences for autistic adults. Lay Abstract There are large differences in the level of demographic, psychological, and lifestyle characteristics between autistic and non-autistic adults but also among autistic people. Our goal was to test whether these differences correspond to differences in underlying relationships between these characteristics—also referred to as network structure—to determine which characteristics (and relationships between them) are important. We tested differences in network structure in (1) autistic and non-autistic adults and (2) two previously identified subgroups of autistic adults. We showed that comparing networks of autistic and non-autistic adults provides subtle differences, whereas networks of the autism subgroups were similar. There were also no sex differences in the networks of the autism subgroups. Thus, the previously observed differences in the level of characteristics did not correspond to differences across subgroups in how these characteristics relate to one another (i.e. network structure). Consequently, a focus on differences in characteristics is not sufficient to determine which characteristics (and relationships between them) are of importance. Hence, network analysis provides a valuable tool beyond looking at (sub)group level differences. These results could provide hints for clinical practice, to eventually determine whether psychological distress, cognitive failures, and reduced quality of life in autistic adults can be addressed by tailored support. However, it is important that these results are first replicated before we move toward intervention or support.

Using Network Models in Person-Centered Care in Psychiatry: How Perspectivism Could Help To Draw Boundaries

Preprint

Full-text available

Jul 2022

In this paper, we explore the conceptual problems arising when using network analysis in person-centered care (PCC) in psychiatry. Personalized network models are potentially helpful tools for PCC, but we argue that using them in psychiatric practice raises boundary problems, i.e., problems in demarcating what should and should not be included in the model, which may limit their ability to provide clinically-relevant knowledge. Models can have explanatory and representational boundaries, among others. We argue that we can make more explicit what kind of questions personalized network models can address in PCC, given their representational and explanatory boundaries, using perspectival reasoning.

The Challenges Raised by Comorbidity in Psychiatric Research: The Case of Autism

Article

Full-text available

May 2022
PHILOS PSYCHOL

Despite several criticisms surrounding the DSM classification in psychiatry, a significant bulk of research on mental conditions still operates according to two core assumptions: a) homogeneity, that is the idea that mental conditions are sufficiently homogeneous to justify generalization; b) additive comorbidity, that is the idea that the coexistence of multiple conditions in the same individual can be interpreted as additive. In this paper we take autism research as a case study to show that, despite a plethora of criticism, psychiatric research often continues to operate in accordance with this model. Then we argue that such a model runs into problems once facts about comorbidity are taken into account. Finally, we offer some suggestions on how to tackle the challenge raised by comorbidity and its impact on heterogeneity. To do so, we explore transdiagnostic stratification accounts and network models to show that combining these approaches can move us in the right direction.

Network analysis of multivariate data in psychological science

Article

Full-text available

Aug 2021

In recent years, network analysis has been applied to identify and analyse patterns of statistical association in multivariate psychological data. In these approaches, network nodes represent variables in a data set, and edges represent pairwise conditional associations between variables in the data, while conditioning on the remaining variables. This Primer provides an anatomy of these techniques, describes the current state of the art and discusses open problems. We identify relevant data structures in which network analysis may be applied: cross-sectional data, repeated measures and intensive longitudinal data. We then discuss the estimation of network structures in each of these cases, as well as assessment techniques to evaluate network robustness and replicability. Successful applications of the technique in different research areas are highlighted. Finally, we discuss limitations and challenges for future research. Network analysis allows the investigation of complex patterns and relationships by examining nodes and the edges connecting them. Borsboom et al. discuss the adoption of network analysis in psychological research.

Objective and subjective psychosocial outcomes in adults with autism spectrum disorder: A 6-year longitudinal study

Article

Full-text available

Jun 2021
AUTISM

Lay abstract: Previous research has shown that relatively few adults with autism have a paid job or live on their own. However, outcomes also vary a lot and may depend on many different factors. In this study, we examined the level of functioning and happiness of 917 adults with autism (425 men and 492 women) aged 18-65 years. Most of them were of average to high intellectual ability. Over 6 years, we measured whether they had a paid job, close friendships and lived on their own (i.e. their objective functioning). We also measured how happy they felt. Objectively, most autistic adults did fairly to very well. Those with better objective outcomes (e.g. those with paid work) also tended to be happier. Most adults improved in objective functioning and happiness over 6 years. Participants with a lower intellectual ability, more autism traits, mental health problems and younger age had poorer objective outcomes. Participants with more autism traits and mental health problems were less happy. Autistic men and women functioned at similar levels and were equally happy. We found important factors that predict a better (or worse) outcome for autistic adults. Overall, compared with some previous research, our findings give a more positive picture of the outcomes for autistic adults with average to high intellectual abilities.

The value of clinical and translational neuroscience approaches to psychiatric illness

Article

Full-text available

Jan 2019

Borsboom et al. confuse biological approaches with extreme biological reductionism and common-cause models of psychopathology. In muddling these concepts, they mistakenly throw the baby out with the bathwater. Here, we highlight recent work underscoring the unique value of clinical and translational neuroscience approaches for understanding the nature and origins of psychopathology and for developing improved intervention strategies.

Conceptualizing neurodevelopmental disorders as networks: Promises and challenges

Article

Mar 2019

The target article by Borsboom et al. proposes network models as an alternative to reductionist approaches in the analysis of mental disorders, using mood disorders such as depression and anxiety as examples. We ask how this framework can be applied to neurodevelopmental disorders such as autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Specifically, we raise a number of promises and challenges when conceptualizing neurodevelopmental disorders as networks.

Indeed, not really a brain disorder: Implications for reductionist accounts of addiction

Article

Full-text available

Mar 2019

Borsboom et al.’s formulation provides an opportunity for a fundamental rethink about the “brain disease model” of addiction that dominates research, treatment, policy, and lay understanding of addiction. We also demonstrate how the American opioid crisis provides a contemporary example of how “brain disease” is not moderated by the environmental context but is instead crucially dependent upon it.

Reductionism in retreat

Article

Mar 2019

We address the commentaries on our target article in terms of four major themes. First, we note that virtually all commentators agree that mental disorders are not brain disorders in the common interpretation of these terms, and establish the consensus that explanatory reductionism is not a viable thesis. Second, we address criticisms to the effect that our article was misdirected or aimed at a straw man; we argue that this is unlikely, given the widespread communication of reductionist slogans in psychopathology research and society. Third, we tackle the question of whether intentionality, extended systems, and multiple realizability are as problematic as claimed in the target article, and we present a number of nuances and extensions with respect to our article. Fourth, we discuss the question of how the network approach should incorporate biological factors, given that wholesale reductionism is an unlikely option.

The biology of mental disorders: What are we talking about?

Article

Jan 2019

Alfonso Troisi

After the Darwinian revolution, biology is not only the study of the operation of structural elements (functional biology), but also the study of adaption and phylogenetic history (evolutionary biology). From an evolutionary perspective, the biology of mental disorders is not just “neurobiology and genetic constitution” but also adaptive reactions to adverse situations. Evolutionary explanations of mental disorders are biological and non-reductionist.

A Bayesian Network Analysis of Posttraumatic Stress Disorder Symptoms in Adults Reporting Childhood Sexual Abuse

Article

Full-text available

Jul 2017

Background: The network approach to mental disorders offers a novel framework for conceptualizing posttraumatic stress disorder (PTSD) as a causal system of interacting symptoms. Objective: In this study, we extended this work by estimating the structure of relations among PTSD symptoms in adults reporting personal histories of childhood sexual abuse (CSA; N = 179). Method: We employed two complementary methods. First, using the graphical LASSO, we computed a sparse, regularized partial correlation network revealing associations (edges) between pairs of PTSD symptoms (nodes). Next, using a Bayesian approach, we computed a directed acyclic graph (DAG) to estimate a directed, potentially causal model of the relations among symptoms. Results: For the first network, we found that physiological reactivity to reminders of trauma, dreams about the trauma, and lost of interest in previously enjoyed activities were highly central nodes. However, stability analyses suggest that these findings were unstable across subsets of our sample. The DAG suggests that becoming physiologically reactive and upset in response to reminders of the trauma may be key drivers of other symptoms in adult survivors of CSA. Conclusions: Our study illustrates the strengths and limitations of these network analytic approaches to PTSD.

Child and Adult Factors Related to Quality of Life in Adults with Autism

Article

Full-text available

Jun 2017
J AUTISM DEV DISORD

The WHO Quality of Life-Brief questionnaire was used to assess quality of life (QoL) among 52 adults with autism (mean age 49 years) followed-up since childhood. Overall, assessments of QOL were more positive than measures of objective social outcome (jobs, independence, relationships etc.) but correlations between caregiver and self-reports were low. Informant ratings indicated few correlations between current QoL and any child or adult factors. On self-report ratings, QoL was significantly negatively correlated with severity of repetitive behaviours in childhood; higher QoL was positively associated with better adult social outcomes. However, only a minority of adults (n = 22) could provide self-report data and findings highlight the need to develop valid measures for assessing the well-being of adults with autism. Electronic supplementary material The online version of this article (doi:10.1007/s10803-017-3105-5) contains supplementary material, which is available to authorized users.

Multicausal systems ask for multicausal approaches: A network perspective on subjective well-being in individuals with autism spectrum disorder

Article

Full-text available

Aug 2016
AUTISM

Given the heterogeneity of autism spectrum disorder, an important limitation of much autism spectrum disorder research is that outcome measures are statistically modeled as separate dependent variables. Often, their multivariate structure is either ignored or treated as a nuisance. This study aims to lift this limitation by applying network analysis to explicate the multivariate pattern of risk and success factors for subjective well-being in autism spectrum disorder. We estimated a network structure for 27 potential factors in 2341 individuals with autism spectrum disorder to assess the centrality of specific life domains and their importance for well-being. The data included both self- and proxy-reported information. We identified social satisfaction and societal contribution as the strongest direct paths to subjective well-being. The results suggest that an important contribution to well-being lies in resources that allow the individual to engage in social relations, which influence well-being directly. Factors most important in determining the network’s structure include self-reported IQ, living situation, level of daily activity, and happiness. Number of family members with autism spectrum disorder and openness about one’s diagnosis are least important of all factors for subjective well-being. These types of results can serve as a roadmap for interventions directed at improving the well-being of individuals with autism spectrum disorder.

Estimating Psychological Networks and their Accuracy: a Tutorial Paper

Article

Full-text available

Apr 2016
BEHAV RES METHODS

The usage of psychological networks that conceptualize behavior as a complex interplay of psychological and other components has gained increasing popularity in various research fields. While prior publications have tackled the topics of estimating and interpreting such networks, little work has been conducted to check how accurate (i.e., prone to sampling variation) networks are estimated, and how stable (i.e., interpretation remains similar with less observations) inferences from the network structure (such as centrality indices) are. In this tutorial paper, we aim to introduce the reader to this field and tackle the problem of accuracy under sampling variation. We first introduce the current state-of-the-art of network estimation. Second, we provide a rationale why researchers should investigate the accuracy of psychological networks. Third, we describe how bootstrap routines can be used to (A) assess the accuracy of estimated network connections, (B) investigate the stability of centrality indices, and (C) test whether network connections and centrality estimates for different variables differ from each other. We introduce two novel statistical methods: for (B) the correlation stability coefficient, and for (C) the bootstrapped difference test for edge-weights and centrality indices. We conducted and present simulation studies to assess the performance of both methods. Finally, we developed the free R-package bootnet that allows for estimating psychological networks in a generalized framework in addition to the proposed bootstrap methods. We showcase bootnet in a tutorial, accompanied by R syntax, in which we analyze a dataset of 359 women with posttraumatic stress disorder available online. Electronic supplementary material The online version of this article (doi:10.3758/s13428-017-0862-1) contains supplementary material, which is available to authorized users.

A Prospective Study on How Symptoms in a Network Predict the Onset of Depression

Article

Full-text available

Apr 2016

Prevalence of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2010

Article

Full-text available

Mar 2014

Problem/Condition: Autism spectrum disorder (ASD). Period Covered: 2010. Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving special education services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides updated prevalence estimates for ASD from the 2010 surveillance year. In addition to prevalence estimates, characteristics of the population of children with ASD are described. Results: For 2010, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ <= 70), 23% in the borderline range (IQ = 71-85), and 46% in the average or above average range of intellectual ability (IQ > 85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity. Interpretation: These findings from CDC's ADDM Network, which are based on 2010 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD in multiple communities in the United States. Because the ADDM Network sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States population. Consistent with previous reports from the ADDM Network, findings from the 2010 surveillance year were marked by significant variations in ASD prevalence by geographic area, sex, race/ethnicity, and level of intellectual ability. The extent to which this variation might be attributable to diagnostic practices, underrecognition of ASD symptoms in some racial/ethnic groups, socioeconomic disparities in access to services, and regional differences in clinical or school-based practices that might influence the findings in this report is unclear. Public Health Action: ADDM Network investigators will continue to monitor the prevalence of ASD in select communities, with a focus on exploring changes within these communities that might affect both the observed prevalence of ASD and population-based characteristics of children identified with ASD. Although ASD is sometimes diagnosed by 2 years of age, the median age of the first ASD diagnosis remains older than age 4 years in the ADDM Network communities. Recommendations from the ADDM Network include enhancing strategies to address the need for 1) standardized, widely adopted measures to document ASD severity and functional limitations associated with ASD diagnosis; 2) improved recognition and documentation of symptoms of ASD, particularly among both boys and girls, children without intellectual disability, and children in all racial/ethnic groups; and 3) decreasing the age when children receive their first evaluation for and a diagnosis of ASD and are enrolled in community-based support systems.

Psychiatric Co-occurring Symptoms and Disorders in Young, Middle-Aged, and Older Adults with Autism Spectrum Disorder

Article

Full-text available

Jun 2016
J AUTISM DEV DISORD

Although psychiatric problems are less prevalent in old age within the general population, it is largely unknown whether this extends to individuals with autism spectrum disorders (ASD). We examined psychiatric symptoms and disorders in young, middle-aged, and older adults with and without ASD (Nmax = 344, age 19–79 years, IQ > 80). Albeit comparable to other psychiatric patients, levels of symptoms and psychological distress were high over the adult lifespan; 79 % met criteria for a psychiatric disorder at least once in their lives. Depression and anxiety were most common. However, older adults less often met criteria for any psychiatric diagnosis and, specifically, social phobia than younger adults. Hence, despite marked psychological distress, psychiatric problems are also less prevalent in older aged individuals with ASD. Electronic supplementary material The online version of this article (doi:10.1007/s10803-016-2722-8) contains supplementary material, which is available to authorized users.

Measuring Depression Over Time . . . or not? Lack of Unidimensionality and Longitudinal Measurement Invariance in Four Common Rating Scales of Depression

Article

Full-text available

Jan 2016

In depression research, symptoms are routinely assessed via rating scales and added to construct sum-scores. These scores are used as a proxy for depression severity in cross-sectional research, and differences in sum-scores over time are taken to reflect changes in an underlying depression construct. To allow for such interpretations, rating scales must (a) measure a single construct, and (b) measure that construct in the same way across time. These requirements are referred to as unidimensionality and measurement invariance. We investigated these 2 requirements in 2 large prospective studies (combined n = 3,509) in which overall depression levels decrease, examining 4 common depression rating scales (1 self-report, 3 clinician-report) with different time intervals between assessments (between 6 weeks and 2 years). A consistent pattern of results emerged. For all instruments, neither unidimensionality nor measurement invariance appeared remotely tenable. At least 3 factors were required to describe each scale, and the factor structure changed over time. Typically, the structure became less multifactorial as depression severity decreased (without however reaching unidimensionality). The decrease in the sum-scores was accompanied by an increase in the variances of the sum-scores, and increases in internal consistency. These findings challenge the common interpretation of sum-scores and their changes as reflecting 1 underlying construct. The violations of common measurement requirements are sufficiently severe to suggest alternative interpretations of depression sum-scores as formative instead of reflective measures. We discuss the possible causes of these violations such as response shift bias, restriction of range, and regression to the mean. (PsycINFO Database Record

Network Approach to Autistic Traits: Group and Subgroup Analyses of ADOS Item Scores

Article

Full-text available

Jul 2015
J AUTISM DEV DISORD

A network conceptualization might contribute to understanding the occurrence and interacting nature of behavioral traits in the autism realm. Networks were constructed based on correlations of item scores of the Autism Diagnostic Observation Schedule for Modules 1, 2 and 3 obtained for a group of 477 Dutch individuals with developmental disorders. After combining Modules, networks were obtained and compared for male versus female, high- versus low-functioning, seizure versus non-seizure, autism spectrum disorder versus intellectual disability, and younger versus older subjects. The network visualizations and calculated network parameters provide new perspectives that generate new hypothesis and suggest follow-up studies. The approach should be useful in characterizing individuals and groups, in elucidating mechanisms of trait generation and routes to outcome phenotypes, and in suggesting points of intervention.

Consistent superiority of selective serotonin reuptake inhibitors over placebo in reducing depressed mood in patients with major depression

Article

Full-text available

Apr 2015

The recent questioning of the antidepressant effect of selective serotonin reuptake inhibitors (SSRIs) is partly based on the observation that approximately half of company-sponsored trials have failed to reveal a significant difference between active drug and placebo. Most of these have applied the Hamilton depression rating scale to assess symptom severity, the sum score for its 17 items (HDRS-17-sum) serving as effect parameter. In this study, we examined whether the negative outcomes of many SSRI trials may be partly caused by the use of this frequently questioned measure of response. We undertook patient-level post-hoc analyses of 18 industry-sponsored placebo-controlled trials regarding paroxetine, citalopram, sertraline or fluoxetine, and including in total 6669 adults with major depression, the aim being to assess what the outcome would have been if the single item depressed mood (rated 0-4) had been used as a measure of efficacy. In total, 32 drug-placebo comparisons were reassessed. While 18 out of 32 comparisons (56%) failed to separate active drug from placebo at week 6 with respect to reduction in HDRS-17-sum, only 3 out of 32 comparisons (9%) were negative when depressed mood was used as an effect parameter (P<0.001). The observation that 29 out of 32 comparisons detected an antidepressant signal from the tested SSRI suggests the effect of these drugs to be more consistent across trials than previously assumed. Further, the frequent use of the HDRS-17-sum as an effect parameter may have distorted the current view on the usefulness of SSRIs and hampered the development of novel antidepressants.Molecular Psychiatry advance online publication, 28 April 2015; doi:10.1038/mp.2015.53.

Influence of Autism Traits and Executive Functioning on Quality of Life in Children with an Autism Spectrum Disorder

Article

Full-text available

Apr 2015
J AUTISM DEV DISORD

Children with Autism Spectrum Disorders (ASDs) often experience a low Quality of Life (QoL). We studied if IQ, early language development, current autism traits, and daily Executive Functions (EFs) are related to QoL in children (aged 8-12 years) with ASD (N = 120) and typically developing (TD) children (N = 76). Children with ASD showed a lower QoL than TD children. This lower QoL was related to higher levels of autism traits and EF deficits. Moreover, specific autism traits and EFs were related to specific QoL subdomains. The low QoL and the aggravating effects of autism traits and EF deficits indicate a potential to identify and target such factors in treatment to improve QoL.

Sex/Gender Differences and Autism: Setting the Scene for Future Research

Article

Full-text available

Oct 2014
J AM ACAD CHILD PSY

Objective The relationship between sex/gender differences and autism has attracted a variety of research ranging from clinical, neurobiological to etiological, stimulated by the male bias in autism prevalence. Findings are complex and do not always relate to each other in a straightforward manner. Distinct but interlinked questions on the relationship between sex/gender differences and autism remain under addressed. To better understand the implications from existing research and to help design future studies, we propose a four-level conceptual framework to clarify the embedded themes. Method We searched PubMed for publications before September 2014 using search terms “‘sex OR gender OR females’ AND autism.” 1,906 citations were screened for relevance, along with publications identified via additional literature reviews, resulting in 329 reports that were reviewed. Results Level 1 “Nosological and diagnostic challenges” concerns the question “How should autism be defined and diagnosed in males and females?” Level 2 “Sex/gender-independent and sex/gender-dependent characteristics” addresses the question “What are the similarities and differences between males and females with autism?” Level 3 “General models of etiology: liability and threshold” asks the question “How is the liability for developing autism linked to sex/gender?” Level 4 “Specific etiological-developmental mechanisms” focuses on the question “What etiological-developmental mechanisms of autism are implicated by sex/gender and/or sexual/gender differentiation?” Conclusions Using this conceptual framework, findings can be more clearly summarized, and the implications of the links between findings from different levels can become clearer. Based on this four-level framework, we suggest future research directions, methodology, and specific topics in sex/gender differences and autism.

Repetitive Behaviors in Autism and Obsessive–Compulsive Disorder: New Perspectives from a Network Analysis

Article

Full-text available

Aug 2014

The association between autism and obsessive-compulsive disorder (OCD) seems largely dependent upon observed similarities in the repetitive behaviors that manifest in both disorders. The aim of this study was to use a network approach to explore the interactions between these behaviors. We constructed a network based on clinician's perceptions as well as a network based on 213 clinically diagnosed children. In all networks, autism and OCD emerged as two distinct symptom clusters and obsessions and compulsions showed few direct associations with autism symptoms. Further, sensory interests were identified as behaviors that may contribute to the link between autism and OCD. Through network analysis, we expose the symptom pathways that may lead to the perceived association between autism and OCD.

A new method for constructing networks from binary data

Article

Full-text available

Aug 2014

Network analysis is entering fields where network structures are unknown, such as psychology and the educational sciences. A crucial step in the application of network models lies in the assessment of network structure. Current methods either have serious drawbacks or are only suitable for Gaussian data. In the present paper, we present a method for assessing network structures from binary data. Although models for binary data are infamous for their computational intractability, we present a computationally efficient model for estimating network structures. The approach, which is based on Ising models as used in physics, combines logistic regression with model selection based on a Goodness-of-Fit measure to identify relevant relationships between variables that define connections in a network. A validation study shows that this method succeeds in revealing the most relevant features of a network for realistic sample sizes. We apply our proposed method to estimate the network of depression and anxiety symptoms from symptom scores of 1108 subjects. Possible extensions of the model are discussed.

State of the aRt personality research: A tutorial on network analysis of personality data in R

Article

Full-text available

Jul 2015

http://authors.elsevier.com/a/1QhogL4LCa4Wz Network analysis represents a novel theoretical approach to personality. Network approaches motivate alternative ways of analyzing data, and suggest new ways of modeling and simulating personality processes. In the present paper, we provide an overview of network analysis strategies as they apply to personality data. We discuss different ways to construct networks from typical personality data, show how to compute and interpret important measures of centrality and clustering, and illustrate how one can simulate on networks to mimic personality processes. All analyses are illustrated using a data set on the commonly used HEXACO questionnaire using elementary R-code that readers may easily adapt to apply to their own data.

Time Trends Over 16 Years in Incidence-Rates of Autism Spectrum Disorders Across the Lifespan Based on Nationwide Danish Register Data

Article

Full-text available

Feb 2014
J AUTISM DEV DISORD

This study investigated time trends and associated factors of incidence rates of diagnosed autism spectrum disorders (ASD) across the lifespan from 1995 to 2010, using data from the Danish Psychiatric Central Research Registry. First time diagnosis of childhood autism, atypical autism, Asperger's syndrome, or pervasive developmental disorder-unspecified (PDD-NOS) were identified, incidence rates were calculated, and data were fitted using non-linear least squares methods. A total of 14.997 patients were identified and incidence rates for ASD increased from 9.0 to 38.6 per 100,000 person years during the 16-year period. The increases were most pronounced in females, adolescents, adults, and patients with Asperger's syndrome and PDD-NOS.

Quality of life in autism across the lifespan: A meta-analysis

Article

Full-text available

Jan 2014

Autism is a lifelong neurodevelopmental disorder, with a known impact on quality of life. Yet the developmental trajectory of quality of life is not well understood. First, the effect of age on quality of life was studied with a meta-analysis. Our meta-analysis included 10 studies (published between 2004 and 2012) with a combined sample size of 486 people with autism and 17,776 controls. Second, as there were no studies on quality of life of the elderly with autism, we conducted an empirical study on quality of life of the elderly (age range 53-83) with autism (N = 24) and without autism (N = 24). The meta-analysis showed that quality of life is lower for people with autism compared to people without autism, and that the mean effect is large (Cohen's d = -0.96). Age did not have an effect on quality of life. The study concerning the elderly with autism showed that the difference in quality of life is similar in the elderly. Age, IQ and symptom severity did not predict quality of life in this sample. Across the lifespan, people with autism experience a much lower quality of life compared to people without autism. Hence, the quality of life seemed to be independent of someone's age.

Critical slowing down as early warning for the onset and termination of depression

Article

Full-text available

Dec 2013
P NATL ACAD SCI USA

Significance As complex systems such as the climate or ecosystems approach a tipping point, their dynamics tend to become dominated by a phenomenon known as critical slowing down. Using time series of autorecorded mood, we show that indicators of slowing down are also predictive of future transitions in depression. Specifically, in persons who are more likely to have a future transition, mood dynamics are slower and different aspects of mood are more correlated. This supports the view that the mood system may have tipping points where reinforcing feedbacks among a web of symptoms can propagate a person into a disorder. Our findings suggest the possibility of early warning systems for psychiatric disorders, using smartphone-based mood monitoring.

Assessment of quality of life in children and youth with autism spectrum disorder: A critical review

Article

Full-text available

Dec 2013
QUAL LIFE RES

To review the use of quality of life (QOL) measures utilised in children and youth with autism spectrum disorder (ASD). Relevant articles were identified through database searches using MEDLINE, CINAHL Plus with Full Text and SPORTDiscus with Full Text via EBSCO Health Database, PsycINFO and ProQuest Health and Medicine (from 2000 to May 2013). Original research articles were included that measured QOL in children and youth with ASD aged 5-20 years. Searches were limited to articles from peer-reviewed journals, in English or German, and those available in full text. The search identified 1,165 titles and 13 met the inclusion criteria. The review identified a number of QOL measures used in children and youth with ASD, with the most common one being the Pediatric Quality of Life Inventory™ (PedsQL). QOL measures using self-reports were uncommon, and the reliability and validity of QOL measures were not sufficiently reported for this population. Large discrepancies in QOL scores were found between self-reports and proxy-reports. Despite the differences in study design and methodological quality, there was consistency in the results among studies; children and youth with ASD provided lower QOL scores, particularly for social domains, compared to their healthy counterparts. The PedsQL is likely to be an appropriate QOL measure for use in children and youth with ASD. Future research should focus on examining the appropriateness, reliability and validity of QOL self-reports for use in this population.

The network takeover

Article

Full-text available

Dec 2011

Albert-Laszlo Barabasi

Reductionism, as a paradigm, is expired, and complexity, as a field, is tired. Data-based mathematical models of complex systems are offering a fresh perspective, rapidly developing into a new discipline: network science.

Network Analysis: An Integrative Approach to the Structure of Psychopathology

Article

Full-text available

Mar 2013
ANNU REV CLIN PSYCHO

In network approaches to psychopathology, disorders result from the causal interplay between symptoms (e.g., worry → insomnia → fatigue), possibly involving feedback loops (e.g., a person may engage in substance abuse to forget the problems that arose due to substance abuse). The present review examines methodologies suited to identify such symptom networks and discusses network analysis techniques that may be used to extract clinically and scientifically useful information from such networks (e.g., which symptom is most central in a person's network). The authors also show how network analysis techniques may be used to construct simulation models that mimic symptom dynamics. Network approaches naturally explain the limited success of traditional research strategies, which are typically based on the idea that symptoms are manifestations of some common underlying factor, while offering promising methodological alternatives. In addition, these techniques may offer possibilities to guide and evaluate therapeutic interventions.

qgraph: Network Visualizations of Relationships in Psychometric Data

Article

Full-text available

Apr 2012
J STAT SOFTW

We present the qgraph package for R, which provides an interface to visualize data through network modeling techniques. For instance, a correlation matrix can be rep-resented as a network in which each variable is a node and each correlation an edge; by varying the width of the edges according to the magnitude of the correlation, the structure of the correlation matrix can be visualized. A wide variety of matrices that are used in statistics can be represented in this fashion, for example matrices that contain (implied) covariances, factor loadings, regression parameters and p values. qgraph can also be used as a psychometric tool, as it performs exploratory and confirmatory factor analysis, using sem and lavaan; the output of these packages is automatically visualized in qgraph, which may aid the interpretation of results. In this article, we introduce qgraph by applying the package functions to data from the NEO-PI-R, a widely used personality questionnaire.

Preference-Based Health-Related Quality-of-Life Outcomes in Children with Autism Spectrum Disorders

Article

Full-text available

Aug 2012
PHARMACOECONOMICS

Cost-effectiveness analysis of pharmaceutical and other treatments for children with autism spectrum disorders (ASDs) has the potential to improve access to services by demonstrating the value of treatment to public and private payers, but methods for measuring QALYs in children are under-studied. No cost-effectiveness analyses have been undertaken in this population using the cost-per-QALY metric. This study describes health-related quality-of-life (HR-QOL) outcomes in children with ASDs and compares the sensitivity of two generic preference-based instruments relative to ASD-related conditions and symptoms. The study design was cross-sectional with prospectively collected outcome data that were correlated with retrospectively assessed clinical information. Subjects were recruited from two sites of the Autism Treatment Network (ATN) in the US: a developmental centre in Little Rock, Arkansas, and an outpatient psychiatric clinic at Columbia University Medical Center in New York. Children that met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for an ASD by a multidisciplinary team evaluation were asked to participate in a clinical registry. Families of children with an ASD that agreed to be contacted about participation in future research studies as part of the ATN formed the sampling frame for the study. Families were included if the child with the ASD was between 4 and 17 years of age and the family caregiver spoke English. Eligible families were contacted by mail to see if they would be interested in participating in the study with 150 completing surveys. HR-QOL outcomes were described using the Health Utilities Index (HUI) 3 and the Quality of Well-Being Self-Administered (QWB-SA) scale obtained by proxy via the family caregiver. Children were diagnosed as having autistic disorder (76%), pervasive developmental disorder-not otherwise specified [PDD-NOS] (15%), and Asperger's disorder (9%). Average HUI3 and QWB-SA scores were 0.68 (SD 0.21, range 0.07-1) and 0.59 (SD 0.16, range 0.18-1), respectively. The HUI3 score was significantly correlated with clinical variables including adaptive behaviour (ρ = 0.52; p < 0.001) and cognitive functioning (ρ = 0.36; p < 0.001). The QWB-SA score had weak correlation with adaptive behaviour (ρ = 0.25; p < 0.001) and cognitive functioning (ρ = 0.17; p < 0.005). Change scores for the HUI3 were larger than the QWB-SA for all clinical measures. Scores for the HUI3 increased 0.21 points (95% CI 0.14, 0.29) across the first to the third quartile of the cognitive functioning measure compared with 0.05 (95% CI -0.01, 0.11) for the QWB-SA. Adjusted R2 values also were higher for the HUI3 compared with the QWB-SA across all clinical measures. The HUI3 was more sensitive to clinical measures used to characterize children with autism compared with the QWB-SA score. The findings provide a benchmark to compare scores obtained by alternative methods and instruments. Researchers should consider incorporating the HUI3 in clinical trials and other longitudinal research studies to build the evidence base for describing the cost effectiveness of services provided to this important population.

Exploring the Nature and Function of Anxiety in Youth with Autism Spectrum Disorders

Article

Full-text available

Dec 2010

[Clin Psychol Sci Prac 17: 281–292, 2010] This article considers the nosology and pathogenesis of anxiety disorders in youth with autism. The comparability of anxiety in the autism spectrum disorder (ASD) population in relation to the typically developing population has been suggested by some recent findings, but conceptual and empirical ambiguities remain. It is suggested that anxiety may play at least three roles: (a) a downstream consequence of ASD symptoms (e.g., via stress generation through social rejection); (b) a moderator of ASD symptom severity, such that certain core autism symptoms like social skill deficits and repetitive behaviors may be exacerbated by anxiety; and (c) as a proxy of core ASD symptoms. Suggestions for clarifying the nature and function of anxiety in autism are made.

Quality of life of adolescents with autism spectrum disorders: Comparison to adolescents with diabetes

Article

Full-text available

Mar 2012
EUR CHILD ADOLES PSY

Relationships are of great importance during adolescence. Because of their social, communication and behavioral impairments, adolescents with Asperger's syndrome (AS) or high functioning autism (HFA) probably suffer from considerable impairment of their quality of life when facing their peers in school. Nevertheless, only one recent study has been published on this subject, indicating a lower health-related quality of life in children and adolescents with autism spectrum disorders (ASD) than in healthy controls. The goals of our study were to clarify the consequences of autistic disorder without mental retardation on such adolescents' daily lives, and to consider them in comparison with the impact of a chronic somatic disease (diabetes) and with the period of adolescence itself, using the VSP-A questionnaire. Adolescents with diabetes were chosen as a comparison group because of the encumbrance of having a constant need for insulin supplementation, to be assimilated to the constant need for communicative adjustments in teenagers with ASD, and the consequences in daily life. The effects of social skill training and social support on quality of life and the appropriateness of using the VSP-A in this population were also studied. Twenty-six adolescents with AS and HFA, 44 diabetic adolescents, and 250 controls completed a self-administered and validated questionnaire on quality of life, the VSP-A. Scores for adolescents with ASD were significantly lower than those of the control and the diabetic adolescents, especially for friendships, leisure time, and affective and sexual relationships. On the other hand, better scores were obtained for the relationships with parents and teachers and for self-image. Social parameters affected the quality of life of subjects with ASD, such as having friends, regularly participating in a sport, and having the support of a school carer. For subjects with autistic spectrum disorders and without mental retardation, impairment of quality of life is significant in adolescence and young adulthood. Such adolescents are dissatisfied with their relationships, although they often have real motivation to succeed with them. Relevance of VSP-A questionnaire in these special individuals is discussed.

The pathoplasticity of dysphoric episodes: Differential impact of stressful life events on the pattern of depressive symptom inter-correlations

Article

Full-text available

Nov 2011
PSYCHOL MED

Previous research has shown that stressful life events (SLEs) influence the pattern of individual depressive symptoms. However, we do not know how these differences arise. Two theories about the nature of psychiatric disorders have different predictions about the source of these differences: (1) SLEs influence depressive symptoms and correlations between them indirectly, via an underlying acute liability to develop a dysphoric episode (DE; common cause hypothesis); and (2) SLEs influence depressive symptoms and correlations between them directly (network hypothesis). The present study investigates the predictions of these two theories. We divided a population-based sample of 2096 Caucasian twins (49.9% female) who reported at least two aggregated depressive symptoms in the last year into four groups, based on the SLE they reported causing their symptoms. For these groups, we calculated tetrachoric correlations between the 14 disaggregated depressive symptoms and, subsequently, tested whether the resulting correlation patterns were significantly different and if those differences could be explained by underlying differences in a single acute liability to develop a DE. The four SLE groups had markedly different correlation patterns between the depressive symptoms. These differences were significant and could not be explained by underlying differences in the acute liability to develop a DE. Our results are not compatible with the common cause perspective but are consistent with the predictions of the network hypothesis. We elaborate on the implications of a conceptual shift to the network perspective for our diagnostic and philosophical approach to the concept of what constitutes a psychiatric disorder.

Perceived Causal Relations

Article

Full-text available

Aug 2011

Researchers have argued that the investigation of causal interrelationships between symptoms may help explain the high comorbidity rate between certain psychiatric disorders. Clients' own attributions concerning the causal interrelationships linking the co-occurrence of their symptoms represent data that may inform their clinical case conceptualization, treatment, and psychological theory regarding the etiology of comorbid disorders. The present study developed and evaluated a novel psychological assessment methodology for measuring Perceived Causal Relations (PCR) and examined its psychometric properties as applied to the question of whether posttraumatic stress and anxiety symptoms represent causal risk factors for depressive symptoms in 225 undergraduates. Participants attributed their symptoms of anxiety and posttraumatic reexperiencing as significant causes of their depressive symptoms. Exploratory analyses identified a listing of symptoms reliably attributed as significant causes of other symptoms and functional impairment, as well as a listing of symptoms reliably attributed as significant effects (outcomes) of other symptoms and functional impairment. The PCR method has promise as an idiographic approach to assessing the causes and consequences of comorbid psychiatric symptoms and associated functional impairment. Research is required to assess the relevance and replicate these findings in distinct psychiatric groups experiencing various symptomatic presentations. Future research may also examine PCR ratings associating other individual differences, for example, between measures of history (e.g., life events), life choices, and personality.

Regression Shrinkage and Selection Via the Lasso

Article

Jan 1996

Robert Tibshirani

We propose a new method for estimation in linear models. The ‘lasso’ minimizes the residual sum of squares subject to the sum of the absolute value of the coefficients being less than a constant. Because of the nature of this constraint it tends to produce some coefficients that are exactly 0 and hence gives interpretable models. Our simulation studies suggest that the lasso enjoys some of the favourable properties of both subset selection and ridge regression. It produces interpretable models like subset selection and exhibits the stability of ridge regression. There is also an interesting relationship with recent work in adaptive function estimation by Donoho and Johnstone. The lasso idea is quite general and can be applied in a variety of statistical models: extensions to generalized regression models and tree‐based models are briefly described.

The architecture of complex weighted networks

Article

Jan 2007

Who is happy?

Article

Jan 1995

Exploring sex differences in autistic traits: A factor analytic study of adults with autism

Article

Nov 2016
AUTISM

Research has highlighted potential differences in the phenotypic and clinical presentation of autism spectrum conditions across sex. Furthermore, the measures utilised to evaluate autism spectrum conditions may be biased towards the male autism phenotype. It is important to determine whether these instruments measure the autism phenotype consistently in autistic men and women. This study evaluated the factor structure of the Autism Spectrum Quotient Short Form in a large sample of autistic adults. It also systematically explored specific sex differences at the item level, to determine whether the scale assesses the autism phenotype equivalently across males and females. Factor analyses were conducted among 265 males and 285 females. A two-factor structure consisting of a social behaviour and numbers and patterns factor was consistent across groups, indicating that the latent autism phenotype is similar among both autistic men and women. Subtle differences were observed on two social behaviour item thresholds of the Autism Spectrum Quotient Short Form, with women reporting scores more in line with the scores expected in autism on these items than men. However, these differences were not substantial. This study showed that the Autism Spectrum Quotient Short Form detects autistic traits equivalently in males and females and is not biased towards the male autism phenotype.

Regression Shrinkage and Selection via the LASSO

Article

Jan 1996

R. J. Tibshirani

Clinical assessment of ASD in adults using self- and other-report: Psychometric properties and validity of the Adult Social Behavior Questionnaire (ASBQ)

Article

Apr 2016
RES AUTISM SPECT DIS

Prevalence of autism spectrum disorder among children aged 8 years-autism and developmental disabilities monitoring network, 11 sites, United States

Article

Mar 2014

Jon Baio

Description of System: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system in the United States that provides estimates of the prevalence of ASD and other characteristics among children aged 8 years whose parents or guardians live in 11 ADDM sites in the United States. ADDM surveillance is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional providers in the community. Multiple data sources for these evaluations include general pediatric health clinics and specialized programs for children with developmental disabilities. In addition, most ADDM Network sites also review and abstract records of children receiving specialeducation services in public schools. The second phase involves review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if a comprehensive evaluation of that child completed by a qualified professional describes behaviors consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides updated prevalence estimates for ASD from the 2010 surveillance year. In addition to prevalence estimates, characteristics of the population of children with ASD are described. Results: For 2010, the overall prevalence of ASD among the ADDM sites was 14.7 per 1,000 (one in 68) children aged 8 years. Overall ASD prevalence estimates varied among sites from 5.7 to 21.9 per 1,000 children aged 8 years. ASD prevalence estimates also varied by sex and racial/ethnic group. Approximately one in 42 boys and one in 189 girls living in the ADDM Network communities were identified as having ASD. Non-Hispanic white children were approximately 30% more likely to be identified with ASD than non-Hispanic black children and were almost 50% more likely to be identified with ASD than Hispanic children. Among the seven sites with sufficient data on intellectual ability, 31% of children with ASD were classified as having IQ scores in the range of intellectual disability (IQ ≤70), 23% in the borderline range (IQ = 71-85), and 46% in the average or above average range of intellectual ability (IQ > 85). The proportion of children classified in the range of intellectual disability differed by race/ethnicity. Approximately 48% of non-Hispanic black children with ASD were classified in the range of intellectual disability compared with 38% of Hispanic children and 25% of non-Hispanic white children. The median age of earliest known ASD diagnosis was 53 months and did not differ significantly by sex or race/ethnicity. Interpretation: These findings from CDC's ADDM Network, which are based on 2010 data reported from 11 sites, provide updated population-based estimates of the prevalence of ASD in multiple communities in the United States. Because the ADDM Network sites do not provide a representative sample of the entire United States, the combined prevalence estimates presented in this report cannot be generalized to all children aged 8 years in the United States population. Consistent with previous reports from the ADDM Network, findings from the 2010 surveillance year were marked by significant variations in ASD prevalence by geographic area, sex, race/ethnicity, and level of intellectual ability. The extent to which this variation might be attributable to diagnostic practices, underrecognition of ASD symptoms in some racial/ethnic groups, socioeconomic disparities in access to services, and regional differences in clinical or school-based practices that might influence the findings in this report is unclear. Public Health Action: ADDM Network investigators will continue to monitor the prevalence of ASD in select communities, with a focus on exploring changes within these communities that might affect both the observed prevalence of ASD and population-based characteristics of children identified with ASD. Although ASD is sometimes diagnosed by 2 years of age, the median age of the first ASD diagnosis remains older than age 4 years in the ADDM Network communities. Recommendations from the ADDM Network include enhancing strategies to address the need for 1) standardized, widely adopted measures to document ASD severity and functional limitations associated with ASD diagnosis; 2) improved recognition and documentation of symptoms of ASD, particularly among both boys and girls, children without intellectual disability, and children in all racial/ethnic groups; and 3) decreasing the age when children receive their first evaluation for and a diagnosis of ASD and are enrolled in community-based support systems.

Contextual Factors Predict Patterns of Change in Functioning over 10 Years Among Adolescents and Adults with Autism Spectrum Disorders

Article

Aug 2015

In the present study, we jointly employ and integrate variable- and person-centered approaches to identify groups of individuals with autism spectrum disorders (ASD) who have similar profiles of change over a period of 10 years across three critical domains of functioning: maladaptive behaviors, autism symptoms, and daily living skills. Two distinct developmental profiles were identified. Above and beyond demographic and individual characteristics, aspects of both the educational context (level of inclusion) and the family context (maternal positivity) were found to predict the likelihood of following a positive pattern of change. Implementing evidence-based interventions that target the school and home environments during childhood and adolescence may have lasting impacts on functioning into adulthood for individuals with ASD.

Subjective and objective dimensions of quality of life in psychiatric patients: A factor analytical approach: The South Verona Outcome Project 4

Article

Mar 2001

Mirella Ruggeri

Background Both subjective and objective information is necessary to assess quality of life (QOL). Aims To explore the role of subjective and objective QOL dimensions and their cross-sectional and longitudinal predictors. Method The relationship between QOL, as measured by the Lancashire Quality of Life Profile (LQL), and demographic variables, diagnosis, psychopathology, disability, functioning, affect balance, self-esteem, service use and service satisfaction was investigated at two points in time, using factor analysis and multiple regression techniques. Results One subjective and two objective LQL factors with strong face validity were identified. Cross-sectional predictors of the subjective factor were primarily subjective measures; longitudinally, few predictors of this factor were identified. The cross-sectional and longitudinal predictors of the objective factors were primarily demographic and observer-rated measures. Conclusions Subjective and objective data are distinct types of information. Objective measures may be more suitable in detecting treatment effects. Subjective information is necessary to complete the QOL picture and to enhance the interpretation of objective data.

The Differential Influence Of Life Stress On Individual Symptoms Of Depression

Article

Feb 2015
ACTA PSYCHIAT SCAND

Objective Life stress consistently increases the incidence of major depression. Recent evidence has shown that individual symptoms of major depressive disorder (MDD) differ in important dimensions such as their genetic and etiological background, but the impact of stress on individual MDD symptoms is not known. Here, we assess whether stress affects depression symptoms differentially.Method We used the chronic stress of medical internship to examine changes of the nine Diagnostic and Statistical Manual (DSM)-5 criterion symptoms for depression in 3021 interns assessed prior to and throughout internship.ResultsAll nine depression symptoms increased in response to stress (all P < 0.001), on average by 173%. Symptom increases differed substantially from each other (P < 0.001), with psychomotor problems (289%) and interest loss (217%) showing the largest increases, and suicidal ideation (146%) and sleep problems (52%) the smallest. Symptoms also differed in their severities under stress (P < 0.001): Fatigue, appetite problems and sleep problems were most prevalent; psychomotor problems and suicidal ideation were least prevalent.Conclusion Stress differentially affects the DSM-5 depressive symptoms. Analyses of individual symptoms reveal important insights obfuscated by sum-scores.

Informant Agreement for Youth with Autism Spectrum Disorder or Intellectual Disability: A Meta-analysis

Article

Sep 2014

This study investigated informant agreement on emotional and behavior problems and social skills in youth with autism spectrum disorder or intellectual disability using meta-analytic methods. Forty-nine studies were included, consisting of 107 effect sizes. The mean weighted effect size across all raters and all behaviors was .36, reflecting moderate agreement. Consistent with meta-analyses in typically developing youth, pairs of similar informants (e.g., parent-parent) demonstrated higher agreement compared to pairs of different raters (e.g., parent-teacher). With all rater pairs combined, agreement was significantly higher for externalizing problems ([Formula: see text] = .42) than either internalizing problems ([Formula: see text] = .35) or social skills ([Formula: see text] = .30). Several factors appear to moderate the level of agreement among informants, including the youth's diagnosis, age, and IQ.

Statistical Analysis of Network Data: Methods and Models

Book

Jan 2009

Eric D. Kolaczyk

Cognitive, language, social, and behavioral outcomes in adults with autism spectrum disorders: A systematic review of longitudinal follow-up studies in adulthood

Article

Jan 2013

Background: Although increasing numbers of children diagnosed with Autism Spectrum Disorders (ASD) are now entering adolescence and adulthood, there is limited research on outcomes post childhood. A systematic review of the existing literature was conducted. Method: PsycINFO, PubMed, MedLine and CINAHL were systematically searched using keywords related to ASD and adolescent and adult outcomes. Studies of individuals diagnosed with ASD in childhood and followed up into adulthood were identified and reviewed. Only studies with samples sizes >10, mean age at outcome >16 years and at least one previous assessment in childhood (<16 years) were included. Results: Twenty-five studies meeting criteria were identified. Reported outcomes in adulthood were highly variable across studies. Although social functioning, cognitive ability and language skills remained relatively stable in some studies, others reported deterioration over time. Adaptive functioning tended to improve in most studies. Diagnosis of autism or ASD was generally stable, although severity of autism-related behavioural symptoms was often reported to improve. Childhood IQ and early language ability appeared to be the strongest predictors of later outcome, but few studies examined other early variables associated with adult functioning. Discussion: Implications of the findings are discussed in relation to methodological challenges in longitudinal outcome research and future research directions.

Article

Sep 2013
RES AUTISM SPECT DIS

This paper examines health-related quality of life (HRQoL) of children age 6–11 years with an autism spectrum disorder (ASD) using the Child Health and Illness Profile – Child Edition (CHIP–CE). We further examine associations of HRQoL scores with measures of behavior using regression models. Overall HRQoL scores are lower than those for normative samples. We find that both externalizing and internalizing behaviors (measured with the Child Behavior Checklist) are correlated with HRQoL as are several of the subscales of the aberrant behavior checklist. These results suggest that some potentially modifiable aspects of ASD, in particular ASD-related and aberrant behaviors, are associated with HRQoL. These associations are suggestive of the potential for improvements in behaviors in some domains having the potential to improve HRQoL. Future studies should determine whether improvements in behaviors are associated with improvements in HRQoL.

Node Centrality in Weighted Networks: Generalizing Degree and Shortest Paths

Article

Jul 2010
SOC NETWORKS

Ties often have a strength naturally associated with them that differentiate them from each other. Tie strength has been operationalized as weights. A few network measures have been proposed for weighted networks, including three common measures of node centrality: degree, closeness, and betweenness. However, these generalizations have solely focused on tie weights, and not on the number of ties, which was the central component of the original measures. This paper proposes generalizations that combine both these aspects. We illustrate the benefits of this approach by applying one of them to Freeman’s EIES dataset.

Who is Happy?

Article

Jan 1995

A flood of new studies explores people's subjective well-being (SWB) Frequent positive affect, infrequent negative affect, and a global sense of satisfaction with life define high SWB These studies reveal that happiness and life satisfaction are similarly available to the young and the old, women and men, blacks and whites, the rich and the working-class Better clues to well-being come from knowing about a person's traits, close relationships, work experiences, culture, and religiosity We present the elements of an appraisal-based theory of happiness that recognizes the importance of adaptation, cultural world-view, and personal goals

Social Skill Deficits and Anxiety in High-Functioning Adolescents With Autism Spectrum Disorders

Article

May 2004

Scott Bellini

The present study examined the prevalence and types of anxiety exhibited by high-functioning adolescents With autism spectrum disorders and factors related to this anxiety. Results suggest that adolescents With autism spectrum disorders exhibit anxiety levels that are significantly higher than those of the general population. The study found a loW negative correlation betWeen assertive social skills and social anxiety. In addition, a moderate curvilinear relationship Was found betWeen empathic skills and the various social anxiety measures. Results of the study support an emerging body of research demonstrating elevated anxiety levels in high-functioning individuals With autism spectrum disorders.

Assessing Subjective Well-Being: Progress and Opportunities

Article

Feb 1994
SOC INDIC RES

Ed Diener

Subjective well-being (SWB) comprises people's longer-term levels of pleasant affect, lack of unpleasant affect, and life satisfaction. It displays moderately high levels of cross-situational consistency and temporal stability. Self-report measures of SWB show adequate validity, reliability, factor invariance, and sensitivity to change. Despite the success of the measures to date, more sophisticated approaches to defining and measuring SWB are now possible. Affect includes facial, physiological, motivational, behavioral, and cognitive components. Self-reports assess primarily the cognitive component of affect, and thus are unlikely to yield a complete picture of respondents' emotional lives. For example, denial may influence self-reports of SWB more than other components. Additionally, emotions are responses which vary on a number of dimensions such as intensity, suggesting that mean levels of affect as captured by existing measures do not give a complete account of SWB. Advances in cognitive psychology indicate that differences in memory retrieval, mood as information, and scaling processes can influence self-reports of SWB. Finally, theories of communication alert us to the types of information that are likely to be given in self-reports of SWB. These advances from psychology suggest that a multimethod approach to assessing SWB will create a more comprehensive depiction of the phenomenon. Not only will a multifaceted test battery yield more credible data, but inconsistencies between various measurement methods and between the various components of well-being will both help us better understand SWB indictors and group differences in well-being. Knowledge of cognition, personality, and emotion will also aid in the development of sophisticated theoretical definitions of subjective well-being. For example, life satisfaction is theorized to be a judgment that respondents construct based on currently salient information. Finally, it is concluded that measuring negative reactions such as depression or anxiety give an incomplete picture of people's well-being, and that it is imperative to measure life satisfaction and positive emotions as well.

Positivity and the Construction of Life Satisfaction Judgments: Global Happiness is not the Sum of its Parts

Article

Jun 2000

The present study investigated how reports of satisfaction with specific versus global domains can be used to assess a disposition towards positivity in subjective well-being reports. College students from 41 societies (N = 7167) completed measures of life satisfaction and ratings of global and specific aspects of their lives. For example, participants rated satisfaction with their education (global) and satisfaction with their professors, textbooks, and lectures (specific). It was hypothesized that global measures would more strongly reflect individual differences in dispositional positivity, that is, a propensity to evaluate aspects of life in general as good. At both the individual and national levels, positivity predicted life satisfaction beyond objective measures. Also, positivity was associated with norms about ideal life satisfaction such that countries and individuals who highly valued positive emotions were more likely to display positivity. The difference between more global versus more concrete measures of satisfaction can be used as an indirect and subtle measure of positivity.

Finding out what matters: validity of quality of life measurement in young people with ASD: Validity of QoL measurement in ASD

Article

Apr 2012
CHILD CARE HLTH DEV

Background: Compared with other conditions there has been a lack of focus on quality of life (QoL) as an outcome measure for children and young people with Autism Spectrum Disorder (ASD). This pilot study aimed to evaluate the validity of existing QoL questionnaires for use with children with ASD aged 8-12 years. Methods: A literature review (1990-2011) identified the PedsQL (Pediatric Quality of Life Inventory) and Kidscreen as robust measures used with children with neurodevelopmental disorders. These measures were completed by 10 children and 11 parents. In addition semi-structured interviews were conducted with 10 parents and four children to explore their experience of completing the QoL questionnaires. Results: Young people with ASD, and their parents, report lower child QoL compared with a normative sample. Framework analysis of the data highlighted six key themes which may affect the validity of generic QoL measures when administered within an ASD sample and which warrant further investigation. Conclusions: Our results indicate that a new condition-specific measure of QoL, grounded in ASD children's own perspectives of their lives, is needed and that such a measure should assess experiences of anxiety and access to special interests when measuring QoL of children with ASD. Active involvement of young people and their families is critical for the development of a theoretical framework for QoL within ASD, and any future development of an ASD-specific measure.

Bayesian model choice and information criteria in sparse generalized linear models

Article

Dec 2011

We consider Bayesian model selection in generalized linear models that are high-dimensional, with the number of covariates p being large relative to the sample size n, but sparse in that the number of active covariates is small compared to p. Treating the covariates as random and adopting an asymptotic scenario in which p increases with n, we show that Bayesian model selection using certain priors on the set of models is asymptotically equivalent to selecting a model using an extended Bayesian information criterion. Moreover, we prove that the smallest true model is selected by either of these methods with probability tending to one. Having addressed random covariates, we are also able to give a consistency result for pseudo-likelihood approaches to high-dimensional sparse graphical modeling. Experiments on real data demonstrate good performance of the extended Bayesian information criterion for regression and for graphical models.

Article

Mar 2011

This study evaluates self- and proxy-reported health-related quality of life (HRQOL) in children and adolescents with autism spectrum disorders (ASD). The study also compares HRQOL in ASD patients with a healthy control sample and a psychiatric reference sample. 42 children and adolescents (39 male, mean age: 12.7 ± 2.6 years, mean IQ: 100.5 ± 20.7) with the diagnosis of autism spectrum disorder (ASD) and their parents completed the Inventory for the Assessment of Quality of Life in Children and Adolescents (ILK). Mean ILK LQ 0-28 scores were 20.6 (± 4.6) (self-report version) and 18.2 (± 4.0) (proxy version). Compared to a reference sample, mean ILK scores from the ASD sample were at the 47th percentile (self-report) and the 33rd percentile (proxy). Compared to children and adolescents with psychiatric disorders, self-reported ILK scores correlated with the 69th percentile, and proxy-reported ILK scores correlated with the 67th percentile. Self-reported HRQOL was significantly higher than proxy-reported HRQOL. No significant correlation was found between HRQOL and age, IQ, or autistic symptoms. HRQOL in children and adolescents with ASD seems to be better than in other psychiatric disorders, but lower than in healthy controls.

Health of the Nation Outcome Scale (HONOS): Research and development

Article

Jan 1998

An instrument was required to quantify and thus potentially measure progress towards a Health of the Nation target, set by the Department of Health, "to improve significantly the health and social functioning of mentally ill people". A first draft was created in consultation with experts and on the basis of literature review. This version was improved during four stages of testing: two preliminary stages, a large field trial involving 2706 patients (rated by 492 clinicians) and tests of the final Health of the Nation Outcome Scales (HoNOS), which included an independent study (n = 197) of reliability and relationship to other instruments. The resulting 12-item instrument is simple to use, covers clinical problems and social functioning with reasonable adequacy, has been generally acceptable to clinicians who have used it, is sensitive to change or the lack of it, showed good reliability in independent trials and compared reasonably well with equivalent items in the Brief Psychiatric Rating Scales and Role Functioning Scales. The key test for HoNOS is that clinicians should want to use it for their own purposes. In general, it has passed that test. A further possibility, that HoNOS data collected routinely as part of a minimum data set, for example for the Care Programme Approach, could also be useful in anonymized and aggregated form for public health purposes, is therefore testable but has not yet been tested.

Relating ASD symptoms to well-being: Moving across different construct levels

Abstract

No full-text available

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