Special Issue on the Topic of Autism Spectrum Disorder

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjcapp-2014-009_s_001"><h3>Background:</h3><p>The female autism spectrum disorder (ASD) phenotype is currently underresearched. Girls with ASD may differ from boys with ASD, yet few studies have tested this hypothesis, particularly among low functioning individuals. This study compared girls and boys with predominantly low functioning ASD and typically developing girls during middle and late childhood across autism symptoms, cognition, sensory overresponsivity, and co-occurring psychopathology.</p></sec><sec id="j_sjcapp-2014-009_s_002"><h3>Methods:</h3><p>Three mental-age–matched groups were compared: girls with ASD (N = 27), boys with ASD (N = 27), and typically developing girls (N = 17). Their ages ranged from 7 to 19 years old. The majority of individuals in the ASD sample had an intelligence quotient of less than 70. Participants were assessed on standard social cognition and attention to detail tasks. Parents completed behavior questionnaires.</p></sec><sec id="j_sjcapp-2014-009_s_003"><h3>Results:</h3><p>Mean levels of autism symptoms were not significantly different for boys and girls with ASD, and they were significantly higher than those of typically developing girls. There were some weak trends for boys with ASD to show more compulsive behavior, inattention/hyperactivity and taste sensory overresponsivity than girls with ASD, but differences were not significant after controlling for multiple comparisons. The Block Design task, assessing attention to detail, showed a significant sex difference, with boys with ASD outperforming both girls with ASD and typically developing girls.</p></sec><sec id="j_sjcapp-2014-009_s_004"><h3>Conclusions:</h3><p>Predominantly low functioning girls with ASD differed from typically developing girls but did not differ from boys with ASD with regard to their levels of autism symptoms, sensory overresponsivity, or co-occurring psychopathology. These data feed into debates about whether ASD assessment tools require sex-specific criteria and to what degree treatment should be tailored to the sex of the individual.</p></sec></abstract>

How do Girls with Low Functioning Autism Compare to Boys with Autism and Typically Developing Girls with regard to Behavior, Cognition, and Psychopathology?

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjcapp-2014-010_s_001"><h3>Background:</h3><p>Autism spectrum disorder (ASD) is diagnosed more often in males than females, with the male-to-female gender ratio reported to be around 4.3:1 to 5:1. It is possible that the underrecognition of ASD in females partially contributes to this uneven ratio. Recent attention has been placed on understanding the processes that give rise to this gender difference in ASD prevalence. Socialization may contribute to the unique presentation of ASD in females, which may underlie this condition’s subsequent underidentification in this group.</p></sec><sec id="j_sjcapp-2014-010_s_002"><h3>Objective:</h3><p>The purpose of this case series is to demonstrate how symptoms of ASD may uniquely manifest in females without co-occurring intellectual impairment.</p></sec><sec id="j_sjcapp-2014-010_s_003"><h3>Method:</h3><p>An examination of three case examples of young women diagnosed with ASD will illustrate the processes that contribute to the atypical manifestation and underidentification of ASD in females.</p></sec><sec id="j_sjcapp-2014-010_s_004"><h3>Results:</h3><p>Across cases, the females in this study demonstrated shared symptom presentations within three domains: 1) unique core symptom manifestation (insistence on sameness, lack of social engagement, and social processing difficulties); 2) heightened psychiatric comorbidities with internalizing disorders (anxiety, depression, and borderline personality traits); and 3) emotional dysregulation. These three domains reflect specific processes that may help to explain the underidentification of ASD in females via diagnostic overshadowing.</p></sec><sec id="j_sjcapp-2014-010_s_005"><h3>Conclusions:</h3><p>Consideration of atypical symptom presentations, heightened comorbidities, and emotion regulation difficulties may help with the understanding of why ASD symptoms in females are commonly underidentified or identified later than they are in males. Social difficulties in combination with internalizing psychiatric disorders and emotional dysregulation may lead to the development of a specific symptom presentation in females that obscures the detection of ASD symptoms. Suggestions for clinical practice are made to promote the accurate identification of ASD and to inform case formulation and treatment planning.</p></sec></abstract>

Underidentification of Autism Spectrum Disorder in Females: A Case Series Illustrating the Unique Presentation of this Disorder in Young Women

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjcapp-2014-011_s_001"><h3>Background:</h3><p>Adults with autism spectrum disorders (ASDs) and with intelligence quotients in the normal range are disproportionately affected by unemployment.</p></sec><sec id="j_sjcapp-2014-011_s_002"><h3>Objective:</h3><p>We sought to assess special interests that could bear potential for employment as well as factors deemed relevant for work performance in adults with ASD.</p></sec><sec id="j_sjcapp-2014-011_s_003"><h3>Method:</h3><p>A newly compiled self-report online questionnaire was administered to high-functioning adults with ASD to assess special interests as well as factors that both interfere with and facilitate work performance.</p></sec><sec id="j_sjcapp-2014-011_s_004"><h3>Results:</h3><p>Participants reported that they spent an average of 26 hours per week on their special interests, and their average level of proficiency was rated as very good. Although special interests were reported to be in the social sciences and the creative fields as often as they were in the natural sciences and technology/engineering, the most common approach taken within those fields was systemizing rather than a creative or knowledge-acquiring pursuit. Social interaction problems with coworkers and superiors as well as sensory issues were most often rated as interfering with work performance. In addition, mental underload was rated as an important factor that interfered with work performance, whereas excessive demands were not. Among the factors most often reported to facilitate work performance were employers’ and colleagues’ awareness of the individual’s ASD diagnosis.</p></sec><sec id="j_sjcapp-2014-011_s_005"><h3>Conclusion:</h3><p>Our data suggest that special interests among individuals with ASD may bear important potential for employment. Given the focus on systemizing in this population, recent efforts to create job opportunities in the information technology sector specifically for high-functioning individuals with ASD are a promising start. However, these efforts should be expanded into other fields.</p></sec></abstract>

Toward the Successful Employment of Adults with Autism: A First Analysis of Special Interests and Factors Deemed Important for Vocational Performance

<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjcapp-2014-012_s_001"><h3>Background:</h3><p>Although existing literature demonstrates the association of attention-deficit/hyperactivity disorder (ADHD) with both substance use (SU) and autism spectrum disorder (ASD), few studies have examined rates of SU among adolescents with elevated ASD symptoms, with or without comorbid ADHD. Clinic-based studies suggest a possible protective effect of ASD against SU, but this has not been confirmed in population-based studies.</p></sec><sec id="j_sjcapp-2014-012_s_002"><h3>Objective:</h3><p>We examined alcohol, tobacco, and drug use in adolescents with either ADHD, elevated autistic traits, or both as compared with controls.</p></sec><sec id="j_sjcapp-2014-012_s_003"><h3>Methods:</h3><p>Subjects (N = 2937) who were 13 to 17 years old from a Missouri population-based large sibship sample were assessed for ADHD, autistic traits, and SU with the use of parent-report questionnaires. The <italic toggle="yes">Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition</italic> ADHD symptom criterion (Criterion A) was applied to the Strengths and Weaknesses of ADHD-symptoms and Normal-behavior (SWAN) questionnaire item responses to determine ADHD diagnosis. The presence of elevated autistic traits was defined as a raw Social Responsiveness Scale (SRS) score of 62 (95<sup>th</sup> percentile for this sample) or higher. SU was determined with the use of three items from the Child Behavior Checklist (CBCL). Statistical methods used included logistic and fractional polynomial regression.</p></sec><sec id="j_sjcapp-2014-012_s_004"><h3>Results:</h3><p>As compared with controls, adolescents with ADHD were at increased risk for alcohol, tobacco, and drug use whether or not they had elevated autistic traits. Adolescents with elevated autistic traits were at significantly increased risk for drug use other than alcohol and tobacco, even if they did not have ADHD. Among those with raw SRS scores in the range of about 20 (normal) to 80 (consistent with mild to moderate ASD), adolescents with ADHD had higher levels of SU than control individuals with similar levels of autistic traits. However, strong conclusions cannot be drawn regarding individuals with very low or very high SRS scores as a result of sparse data.</p></sec><sec id="j_sjcapp-2014-012_s_005"><h3>Conclusions:</h3><p>This study confirms previous research showing an increased risk of SU among adolescents with ADHD. It also provides new information indicating that adolescents with high levels of autistic traits are at elevated risk for alcohol and tobacco use if they have comorbid ADHD; in addition, they may be at high risk for other drug use, even if they do not have comorbid ADHD. Therefore, it should not be assumed that adolescents with mild to moderate ASD have a low risk of SU, especially if ADHD is also present.</p></sec></abstract>

Attention-Deficit/Hyperactivity Disorder, Autistic Traits, and Substance Use Among Missouri Adolescents

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Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

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