Distinct Symptom Network Structure and Shared Central Social Communication Symptomatology in Autism and Schizophrenia: A Bayesian Network Analysis.

Autism (ASD) and schizophrenia spectrum disorders (SCZ) are neurodevelopmental conditions with overlapping and interrelated symptoms. A network analysis approach that represents clinical conditions as a set of "nodes" (symptoms) connected by "edges" (relations among symptoms) was used to compare symptom organization in the two conditions. Gaussian graphical models were estimated using Bayesian methods to model separate symptom networks for adults with confirmed ASD or SCZ diagnoses. Though overall symptom organization differed by diagnostic group, both symptom networks demonstrated high centrality of social communication difficulties. Autism-relevant restricted and repetitive behaviors and schizophrenia-related cognitive-perceptual symptoms were uniquely central to the ASD and SCZ networks, respectively. Results offer recommendations to improve differential diagnosis and highlight potential treatment targets in ASD and SCZ.

Associations between sleep problems and domains relevant to daytime functioning and clinical symptomatology in autism: A meta-analysis.

Autistic individuals experience significantly higher rates of sleep problems compared to the general population, which negatively impacts various aspects of daytime functioning. The strength of associations across domains of functioning has not yet been summarized across studies. The present meta-analysis examined the strength of associations between sleep problems and various domains of daytime functioning in autistic individuals. Searches were conducted in EMBASE, PubMed, Web of Science, and Google Scholar through May 2020. Inclusion criteria were: an index of sleep disturbance in individuals diagnosed with autism spectrum disorder (ASD); data collected prior to any sleep-related intervention; statistical data indicating relations between sleep problems and outcomes relevant to behavior, cognition, and physical or mental health. Exclusion criteria were: statistics characterizing the relationship between sleep disturbance and outcome variables that partialled out covariates; studies examining correlations between different measures of sleep disturbance. Participants totaled 15,074 from 49 published articles and 51 samples, yielding 209 effect sizes. Sleep problems were significantly associated with more clinical symptomatology and worse daytime functioning. Subgroup analyses demonstrated that sleep problems were most strongly associated with internalizing and externalizing symptoms and executive functioning, followed by core autism symptoms, family factors, and adaptive functioning. Findings highlight the far-reaching consequences of sleep problems on daytime functioning for autistic individuals and support the continued prioritization of sleep as a target for intervention through integrated care models to improve wellbeing. LAY SUMMARY: Autistic individuals experience higher rates of sleep problems, such as difficulty falling asleep and staying asleep, compared to the general population. We quantitatively summarized the literature about how sleep problems are related to different aspects of daytime functioning to identify areas that may be most affected by sleep. Sleep problems were related to all areas assessed, with the strongest associations for mood and anxiety symptoms. We recommend prioritizing sleep health in autistic individuals to improve wellbeing and quality of life.

Brief Report: Preliminary Evidence of the N170 as a Biomarker of Response to Treatment in Autism Spectrum Disorder.

Background: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by primary difficulties in social function. Individuals with ASD display slowed neural processing of faces, as indexed by the latency of the N170, a face-sensitive event-related potential. Currently, there are no objective biomarkers of ASD useful in clinical care or research. Efficacy of behavioral treatment is currently evaluated through subjective clinical impressions. To explore whether the N170 might have utility as an objective index of treatment response, we examined N170 before and after receipt of an empirically validated behavioral treatment in children with ASD. Method: Electroencephalography (EEG) data were obtained on a preliminary cohort of preschool-aged children with ASD before and after a 16-week course of PRT and in a subset of participants in waitlist control (16-weeks before the start of PRT) and follow-up (16-weeks after the end of PRT). EEG was recorded while participants viewed computer-generated faces with neutral and fearful affect. Results: Significant reductions in N170 latency to faces were observed following 16 weeks of PRT intervention. Change in N170 latency was not observed in the waitlist-control condition. Conclusions: This exploratory study offers suggestive evidence that N170 latency may index response to behavioral treatment. Future, more rigorous, studies in larger samples are indicated to evaluate whether the N170 may be useful as a biomarker of treatment response.

Face perception predicts affective theory of mind in autism spectrum disorder but not schizophrenia or typical development.

Autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SCZ) have overlapping symptomatology related to difficulties with social cognition. Yet, few studies have directly compared social cognition in ASD, SCZ, and typical development (TD). The current study examined individual differences in face recognition and its relation to affective theory of mind (ToM) in each diagnostic group. Adults with ASD (n = 31), SCZ (n = 43), and TD (n = 47) between the ages of 18 and 48 years-old with full scale IQ above 80 participated in this study. The Reading the Mind in the Eyes Test (RMET) measured affective ToM, and the Benton Facial Recognition Test (BFRT) measured face perception. Adults with ASD and SCZ did not differ in their affective ToM abilities, and both groups showed affective ToM difficulties compared with TD. However, better face recognition ability uniquely predicted better affective ToM ability in ASD. Results suggest that affective ToM difficulties may relate to face processing in ASD but not SCZ. By clarifying the complex nature of individual differences in affective ToM and face recognition difficulties in these disorders, the present study suggests there may be divergent mechanisms underlying pathways to social dysfunction in ASD compared with SCZ. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Looking Back at the Next 40 Years of ASD Neuroscience Research.

During the last 40 years, neuroscience has become one of the most central and most productive approaches to investigating autism. In this commentary, we assemble a group of established investigators and trainees to review key advances and anticipated developments in neuroscience research across five modalities most commonly employed in autism research: magnetic resonance imaging, functional near infrared spectroscopy, positron emission tomography, electroencephalography, and transcranial magnetic stimulation. Broadly, neuroscience research has provided important insights into brain systems involved in autism but not yet mechanistic understanding. Methodological advancements are expected to proffer deeper understanding of neural circuitry associated with function and dysfunction during the next 40 years.

First-Hand Accounts of Interoceptive Difficulties in Autistic Adults.

Interoceptive awareness refers to one's ability to detect, discriminate, and regulate internal bodily and mental processes. Interoceptive challenges in ASD remain under researched and poorly understood. In this study, we analyzed texts of adults who self-identify as autistic describing their interoceptive challenges. Many individuals described limited awareness of hunger, satiation, or thirst, which contributed to eating disordered behavior in some instances. Others described limited awareness or difficulty understanding affective arousal, pain or illness, and difficulty differentiating benign body signals from signals that represent medical concerns. Findings from this study call for increased research attention on this topic, and a need for valid and objective measures for assessing interoception in ASD.

Evaluation of a Peer Mentorship Program for Autistic College Students.

The number of autistic students in colleges is growing rapidly. However, their needs are not being met, and graduation rates among this population remain low. This article describes the implementation and evaluation of the Autism Mentorship Initiative (AMI) for autistic undergraduates (mentees), who received 1-on-1 support from upper-level undergraduate or graduate students (mentors) at their university. We examined changes in college adjustment (n = 16) and grade point average among mentees (n = 19) before and after participation in AMI for two or more semesters. We also examined surveys completed by both mentees (n = 16) and mentors (n = 21) evaluating their experiences in AMI. Data from the Student Adaptation to College Questionnaire showed that mentees displayed lower than average social, emotional, and academic adjustment to college compared with neurotypical norms, but participation in AMI resulted in notable gains in all facets of college adjustment. Survey data revealed that both mentors and mentees reported personal, academic, and professional benefits from participating in AMI. However, no improvements in academic achievement of the mentees were found. This study provided preliminary evidence for the benefits of an easily implemented and cost-effective peer mentorship program for autistic students in a college setting. Lay summary: Why was this program developed?: There are a growing number of autistic students attending college. However, the percentage of autistic students who complete their degree is quite low. We believe that colleges should be offering more support services to address the unique needs of their autistic students.What does the program do?: The Autism Mentorship Initiative (AMI) matches incoming autistic undergraduates with upper-level (third or fourth year) neurotypical undergraduates or graduate students who provide 1-on-1 mentorship. The autistic undergraduates meet regularly with their mentors to discuss personal and professional goals, discuss solutions for problems they are experiencing in college, and discuss ideas for increased integration into college campus life (e.g., joining clubs or attending social events). The neurotypical mentors receive ongoing training from program supervisors about autism and meet regularly with program supervisors to discuss progress with their mentees and troubleshoot issues they may be experiencing with their mentees.How did the researchers evaluate the program?: We evaluated AMI by administering the Student Adaptation to College Questionnaire at multiple time points to examine whether autistic mentees reported improvements in social, emotional, and academic adjustment to college as a result of participating in AMI. In addition to tracking changes in cumulative grade point average (GPA), we also administered program evaluation surveys to determine whether AMI is meeting its core aims and to assess satisfaction with the program from the perspectives of both mentors and mentees.What are the early findings?: While there were no changes in GPA, participation in AMI resulted in notable changes in mentees' academic, social, and emotional adjustment. Both mentors and mentees reported personal, academic, and professional benefits from their participation in AMI.What were the weaknesses of this project?: The sample size was small, so it is questionable whether the findings generalize to a broader autistic student population. In addition, there was no control group, so we cannot be certain that improvements in college adjustment were due to participation in AMI. Moreover, this study only assessed one program at one university in Western Canada, so it is unknown whether this program could be successfully implemented at other universities or in different geographic locations.What are the next steps?: As participation in AMI increases each year, follow-up studies will utilize larger sample sizes. We will seek to obtain control data by examining GPA and college adjustment in autistic students who do not participate in AMI. We will aim to conduct multisite trials to examine whether similar programs can be implemented at other universities.How will this work help autistic adults now and in the future?: We hope that our research will help faculty members and staff from disability support offices to gain ideas and insights in implementing similar-or better-programs at their respective institutions. Our experience is that mentorship programs can be both cost-effective and easily implemented, while offering an invaluable support system to autistic students that may increase the likelihood of degree completion.

Action coordination during a real-world task: Evidence from children with and without autism spectrum disorder.

"Joint action"-the ability to coordinate actions with others-is critical for achieving individual and interpersonal goals and for our collective success as a species. Joint actions require accurate and rapid inferences about others' goals, intentions, and focus of attention, skills that are thought to be impaired in individuals with autism spectrum disorder (ASD). Research to date has not investigated joint action abilities in individuals with ASD during real-world social interactions. We conducted an experimental study that required children with ASD and typically developing children to move tables by themselves or collaboratively through a maze. This involved developing innovative methodologies for measuring action coordination-a critical component of the joint action process. We found that children with ASD are less likely to benefit from the collaboration of a peer than are typically developing children, and they are less likely to synchronize their steps when moving the table. However, these differences were masked when scaffolded by an adult. There was no evidence that ASD differences were due to gross motor delays in the participants with ASD. We argue that action coordination is a highly adaptive social process that is intrinsic to successful human functioning that manifests as atypical synchronization of mind and body in children with ASD.

Adaptive and Maladaptive Bodily Awareness: Distinguishing Interoceptive Sensibility and Interoceptive Attention from Anxiety-Induced Somatization in Autism and Alexithymia.

There is growing interest in "interoception" (i.e., detection and interpretation of internal body signals) as a relevant mechanism contributing to certain symptoms and features of autism spectrum disorder (ASD) and alexithymia. However, inconsistent measurement and operationalization of interoception has led to confusion and inconsistent findings in the literature. In this commentary, we present alternative interpretations of findings from existing studies to demonstrate that ASD and alexithymia are conditions associated with reduced adaptive forms of interoceptive attention (i.e., attention toward bodily signals) but heightened maladaptive forms of interoceptive attention related to anxiety-induced somatization. Differentiating adaptive and maladaptive forms of interoceptive attention reveals a clearer pattern of findings in the research literature for further investigation of interoceptive processes that are involved in the neurobiology of ASD. However, interoception is a complex and multi-faceted construct that requires continual refinement in conceptualization and operationalization. Interoception research may benefit from self-report measures that clearly differentiate adaptive and maladaptive forms of bodily awareness. LAY SUMMARY: Some research suggests that autistic people have difficulty understanding bodily feelings such as hunger, illness, or emotions, whereas some studies have reported the opposite pattern of findings. We argue that this latter subset of studies reached false conclusions from using measures of bodily awareness that largely measure physical symptoms of anxiety. While attention to unpleasant bodily signals is an important ability necessary for maintaining healthy bodily functioning, excessive attention, and worry toward bodily signals can increase anxiety and be harmful.

Autism Spectrum Disorder and Schizophrenia Are Better Differentiated by Positive Symptoms Than Negative Symptoms.

Autism spectrum disorder (ASD) and schizophrenia (SZ) are heterogenous neurodevelopmental disorders that overlap in symptom presentation. The purpose of this study was to specify overlapping symptom domains and to identify symptoms that can reliably differentiate adults with ASD (n = 53), SZ (n = 39), and typical development (TD; n = 40). All participants regardless of diagnosis were administered gold-standard diagnostic assessments of ASD and SZ characteristics including the Autism Diagnostic Observation Schedule (ADOS-2) and the Positive and Negative Syndrome Scale (PANSS). Sensitivity and specificity of the ADOS were assessed using diagnostic cut-off scores. The degree of symptom overlap on these measures between participant groups was analyzed using Analyses of Variance (ANOVAs), Receiver Operating Characteristic (ROC) Curves, and Analyses of Covariance (ANCOVAs) to control for group differences in IQ and sex distributions. The ADOS reliably discriminated ASD and TD adults, but there was a high rate of "false positives" in SZ patients who did not meet the DSM-5 criteria for ASD. To identify the reasons for low specificity in the SZ sample, we categorized ASD and SZ symptoms into 'positive' (presence of atypical behaviors) and 'negative' (absence of typical behaviors) symptoms. ASD and SZ groups overlapped on negative symptoms largely related to the absence of typical social and communicative behaviors, whereas disorder-specific positive symptoms differentiated ASD and SZ. For example, those with ASD scored higher on restricted and repetitive behaviors and stereotyped language, whereas those with SZ scored higher on psychotic symptoms such as delusions and hallucinations. These results suggest that, when making a differential diagnosis between ASD and SZ, clinicians may benefit from focusing on the presence or absence of positive ASD and SZ symptoms. Standardized measures to classify ASD symptoms into positive and negative symptoms have not yet been developed but represent a potentially viable clinical tool.

Autistic and alexithymic traits modulate distinct aspects of face perception.

BACKGROUND: Atypical face processing is a prominent feature of autism spectrum disorder (ASD) but is not universal and is subject to individual variability. This heterogeneity could be accounted for by reliable yet unidentified subgroups within the diverse population of individuals with ASD. Alexithymia, which is characterized by difficulties in emotion recognition and identification, serves as a potential grouping factor. Recent research demonstrates that emotion recognition impairments in ASD are predicted by its comorbidity with alexithymia. The current study assessed the relative influence of autistic versus alexithymic traits on neural indices of face and emotion perception. METHODS: Capitalizing upon the temporal sensitivity of event-related potentials (ERPs), it investigates the distinct contributions of alexithymic versus autistic traits at specific stages of emotional face processing in 27 typically developing adults (18 female). ERP components reflecting sequential stages of perceptual processing (P100, N170 and N250) were recorded in response to fear and neutral faces. RESULTS: The results indicated that autistic traits were associated with structural encoding of faces (N170), whereas alexithymic traits were associated with more complex emotion decoding (N250). CONCLUSIONS: These findings have important implications for deconstructing heterogeneity within ASD.

A meta-analysis on the relationship between interoceptive awareness and alexithymia: Distinguishing interoceptive accuracy and sensibility.

Alexithymia-a trait associated with difficulties understanding one's own emotions-is theorized to stem from deficits in interoceptive awareness, or the ability to detect, accurately monitor, and regulate internal bodily processes. The present meta-analysis analyzed all studies that empirically examined the relationship between alexithymia and interoceptive awareness. Across 66 independent samples (N = 7,146), alexithymia had a small, negative correlation with interoceptive awareness (r = -.162, p = .001, 95% CI [-.252, -.068]), but additional analyses revealed that the strength and directionality of this association was heavily influenced by the specific interoceptive awareness components measured (e.g., interoceptive accuracy vs. sensibility) and the methods used to measure interoceptive awareness (e.g., objective vs. self-report measures). The strength of this relationship was also moderated by diagnosis of participants such that alexithymia was moderately associated with interoceptive awareness in samples with psychiatric and developmental disorders, but the relationship was nonsignificant in healthy, typically developing samples. Results suggest interoception may represent a shared transdiagnostic vulnerability that underlies atypical emotional processing in a variety of disparate clinical populations but that current operationalization and measurement of interoceptive awareness continues to create confusion and inconsistency in the literature. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Systematic review of factors that may influence the outcomes and generalizability of parent-mediated interventions for young children with autism spectrum disorder.

Parent mediated interventions have the potential to positively influence the interactions and developmental outcomes of children with autism spectrum disorder (ASD). However, a range of factors relating to children, parents and caregivers, and study design may impact on outcomes and thus the generalizability of these interventions to the broader community. The objective of this review was to examine factors that may influence the feasibility, appropriateness, effectiveness, and generalizability of parent mediated interventions for children with ASD. We conducted a systematic review, yielding 41 articles. There was substantial variability in the intervention type, intensity, and study quality. Notably, 46 different inclusion/exclusion criteria were reported across studies including factors relating to children's development, access to other services, comorbidities, parental factors, and access to the intervention. Fifteen articles included examination of 45 different factors potentially associated with, or influencing, intervention outcomes including child (e.g., language skills, ASD severity, cognition) and parent (e.g., adherence and fidelity, education) factors. Although there is clear evidence for an increasingly sophisticated (e.g., systematic phased research for some interventions) and diverse (e.g., studies in geographical diverse contexts including low-resource communities) approach to research examining parent mediated interventions, there remains a need for improved study quality and measurement consistency in research, including a detailed examination of factors that may predict, moderate, and mediate intervention effectiveness for children and their parents. Autism Res 2019, 12: 1304-1321. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Parent mediated interventions-in which parents adapt their own behavior or deliver interventions to help their children learn-appear to be effective for some children with autism spectrum disorder. In this review, we identified a range of child, parent, and study design factors that may influence intervention outcomes and ultimately the uptake of these approaches in the community. We suggest that research in this area could be further improved by ensuring that studies include diverse groups of children and parents, and by using study designs that help to establish not only if interventions work, but for whom they work best and why.

Facial Expression Production in Autism: A Meta-Analysis.

This meta-analysis summarized studies that examined group differences on the production of facial expressions in participants with ASD compared to typically developing or nonautistic clinical comparison groups. The overall summary effect from 67 effect sizes representing the average ASD-comparison group differences in facial expressions was -0.481, indicating a moderate effect size. We conducted subgroup analyses to group effect sizes according to separate facial expression abilities identified in the literature. These analyses revealed that participants with ASD display facial expressions less frequently and for less amount of time, and they are less likely to share facial expressions with others or automatically mimic the expressions of real faces or face stimuli. Their facial expressions are also judged to be lower in quality and are expressed less accurately. However, participants with ASD do not express emotions less intensely, nor is their reaction time of expression onset slower in response to odors, startling sensations, or in response to face stimuli in mimicry studies. ASD-comparison group differences were moderated by matching procedures, age, and intellectual functioning of the ASD participants suggesting that persons with higher IQ and larger number of accumulated life experiences are better able to produce facial expressions that are more consistent with "neurotypical" norms. Group differences were also stronger for "covertly elicited" than "explicitly elicited" facial expressions suggesting individuals with ASD may naturally produce facial expressions differently from other populations, but are less impaired in expressing emotions typically when prompted to do so in a laboratory setting. Autism Research 2018, 11: 1586-1601. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: We reviewed studies that compared facial expressions in people with and without autism. Results revealed that facial expressions of people with autism are atypical in appearance and quality and are used atypically to regulate social interactions. The magnitude of these differences was influenced by participant characteristics (e.g. age and intellectual functioning), and by how facial expressions were measured and analyzed in various studies.

A psychometric evaluation of the Multidimensional Social Competence Scale (MSCS) for young adults.

The current study contributes to previous work on measuring the social phenotype in Autism Spectrum Disorder (ASD) by validating a multidimensional test of social competence developed for use with individuals with and without ASD. The "Multidimensional Social Competence Scale" (MSCS) was previously validated as a parent-rating scale with youth 11-18 years with ASD without intellectual disability and typically developing adolescents of comparable age. The current study presents a validation of a self-report version of the MSCS in a non-clinical young adult population (N = 1178, males = 360, females = 817, age range = 17-25 years). The MSCS consists of seven domains that represent social competence: social motivation, social inferencing, demonstrating empathic concern, social knowledge, verbal conversation skills, nonverbal sending skills, and emotion regulation. These domains are theorized to be indicative of the higher-order construct of social competence. A second higher-order theorization of the MSCS structure posits that 3 of these factors are indicative of social responsiveness, and the remaining 4 factors are indicative of social understanding and emotion regulation. Our findings indicated support for each of the theorized multidimensional factor structures. Reliability, optimal scoring, convergent and discriminant validity of the measure, as well as implications for future research are discussed.

How do adults and teens with self-declared Autism Spectrum Disorder experience eye contact? A qualitative analysis of first-hand accounts.

A tendency to avoid eye contact is an early indicator of Autism Spectrum Disorder (ASD), and difficulties with eye contact often persist throughout the lifespan. Eye contact difficulties may underlie social cognitive deficits in ASD, and can create significant social and occupational barriers. Thus, this topic has received substantial research and clinical attention. In this study, we used qualitative methods to analyze self-reported experiences with eye contact as described by teens and adults with self-declared ASD. Results suggest people with a self- declared ASD diagnosis experience adverse emotional and physiological reactions, feelings of being invaded, and sensory overload while making eye contact, in addition to difficulties understanding social nuances, and difficulties receiving and sending nonverbal information. Some data support existing mindblindness frameworks, and hyperarousal or hypoarousal theories of eye contact, but we also present novel findings unaccounted for by existing frameworks. Additionally, we highlight innovative strategies people with self-declared ASD have devised to overcome or cope with their eye contact difficulties.

Alexithymia, but not autism spectrum disorder, may be related to the production of emotional facial expressions.

BACKGROUND: A prominent diagnostic criterion of autism spectrum disorder (ASD) relates to the abnormal or diminished use of facial expressions. Yet little is known about the mechanisms that contribute to this feature of ASD. METHODS: We showed children with and without ASD emotionally charged video clips in order to parse out individual differences in spontaneous production of facial expressions using automated facial expression analysis software. RESULTS: Using hierarchical multiple regression, we sought to determine whether alexithymia (characterized by difficulties interpreting one's own feeling states) contributes to diminished facial expression production. Across groups, alexithymic traits-but not ASD traits, IQ, or sex-were associated with quantity of facial expression production. CONCLUSIONS: These results accord with a growing body of research suggesting that many emotion processing abnormalities observed in ASD may be explained by co-occurring alexithymia. Developmental and clinical considerations are discussed, and it is argued that alexithymia is an important but too often ignored trait associated with ASD that may have implications for subtyping individuals on the autism spectrum.