Mary E. Stewart

Presentation of depression in autism and Asperger syndrome A review

Depression is common in autism and Asperger syndrome, but despite this, there has been little research into this issue. This review considers the current literature on the prevalence, presentation, treatment and assessment of depression in autism and Asperger syndrome. There are diagnostic difficulties when considering depression in autism and Asperger syndrome, as the characteristics of these disorders, such as social withdrawal and appetite and sleep disturbance, are also core symptoms of depression. Impaired verbal and non-verbal communication can mask the symptoms of depression. Symptoms associated with autism and Asperger syndrome such as obsessionality and self-injury may be increased during an episode of depression. There is a clear need to develop specific tools both for diagnostic purposes and for measurement of depression in autism and Asperger syndrome in order to help alleviate the distress caused by this treatable illness.

Profiling executive dysfunction in adults with autism and comorbid learning disability

Executive dysfunction is thought to be primary to autism. We examined differences in executive function between 20 adults with autism and learning disability and 23 individuals with learning disabilities outside the autistic spectrum. All participants were matched for chronological age and full-scale IQ, and were given a battery of tasks assessing fluency, planning, set-shifting, inhibition and working memory. Analyses of the individual tasks revealed very few significant differences between the two groups. However, analyses of composite scores derived for each executive domain revealed that the group with autism showed impaired performance on the working memory and planning tests. Together, these two measures were sufficient to classify participants into their diagnostic groups significantly better than would be expected by chance (75% of the autism group; 65% of the control group). Executive impairments were neither universal nor exclusive to the autism group, and we suggest that an alternative cognitive theory may better explain the cognitive profile we found.

The effects of acute tryptophan depletion on neuropsychological function

Serotonin (5-HT, 5-hydroxytryptamine) may have an important role in the maintenance of normal neuropsychological functioning. The method of acute tryptophan depletion (ATD) provides a pharmacological challenge by which central 5-HT levels can be temporarily decreased and effects on learning, memory and mood examined. Twenty healthy male volunteers were recruited to take part in this within-subject, double-blind, crossover study. Neuropsychological function was evaluated 4-6 h after ingestion of a control or 52 g tryptophan (TRP) depleting amino-acid drink. ATD significantly lowered levels of plasma total and free TRP (p < 0.001), but this did not affect mood or performance on tests of verbal and visuo-spatial learning and memory, attention or executive function. These results contradict previous findings; however, the degree of disruption of central 5-HT levels resulting from the use of the 52 g amino-acid protocol may be an important factor in explaining the lack of effect. By utilizing more specific probes of individual 5-HT receptor subtypes, future studies can fully explore the role of 5-HT in neuropsychological functioning and may elucidate the factors determining vulnerability to the effects of serotonergic dysfunction.

The structure of Cloninger's Tridimensional Personality Questionnaire in a British sample

Abstract This study adds to the very few published reports of the structure of the Tridimensional Personality Questionnaire (TPQ) at both the item and subscale levels. The TPQ was completed by 897 students from Universities within Edinburgh. Exploratory factor analysis was run on the items and the 12 subscales as described by Cloninger, Przybeck, and Svrakic (1991). Harm Avoidance showed high internal consistency both for the whole scale and the subscales; however, this was not the case for Reward Dependence and Novelty Seeking. A three factor solution was extracted from analysis at the scale level which gives support to Cloningers model. However, when analysis was carried out at the item level, three and four factor solutions were extracted with only one factor, that of Harm Avoidance, resembling Cloningers model. The four factors extracted were provisionally named Harm Avoidance, Conscientiousness, Sociability and Impulsiveness. These more closely resemble factors from the Five Factor Model (Costa & McCrae, 1992) and Eysencks three factor model (Eysenck, Eysenck, & Barrett, 1985) than Cloningers theory. It may be necessary to adapt Cloningers model for a British sample, and more generally to question the psychometric structure of the TPQ.

Visual/verbal-analytic reasoning bias as a function of self-reported autistic-like traits: A study of typically developing individuals solving Raven’s Advanced Progressive Matrices

People with autism spectrum condition (ASC) perform well on Raven’s matrices, a test which loads highly on the general factor in intelligence. However, the mechanisms supporting enhanced performance on the test are poorly understood. Evidence is accumulating that milder variants of the ASC phenotype are present in typically developing individuals, and that those who are further along the autistic-like trait spectrum show similar patterns of abilities and impairments as people with clinically diagnosed ASC. We investigated whether self-reported autistic-like traits in a university student sample, assessed using the Autism-Spectrum Quotient (AQ; Baron-Cohen, Wheelwright, Skinner, et al., 2001), predict performance on Raven’s Advanced Progressive Matrices. We found that reporting poorer social skills but better attention switching predicted a higher Advanced matrices score overall. DeShon, Chan, and Weissbein (1995) classified Advanced matrices items as requiring a visuospatial, or a verbal-analytic strategy. We hypothesised that higher AQ scores would predict better performance on visuospatial items than on verbal-analytic items. This prediction was confirmed. These results are consistent with the continuum view and can be explained by the enhanced perceptual functioning theory of performance peaks in ASC. The results also confirm a new prediction about Raven’s Advanced Progressive Matrices performance in people with ASC.

Emotional recognition in autism spectrum conditions from voices and faces

The present study reports on a new vocal emotion recognition task and assesses whether people with autism spectrum conditions (ASC) perform differently from typically developed individuals on tests of emotional identification from both the face and the voice. The new test of vocal emotion contained trials in which the vocal emotion of the sentence were congruent, incongruent, or neutral with respect to the semantic content. We also included a condition in which there was no semantic content (an ‘mmm’ was uttered using an emotional tone). Performance was compared between 11 adults with ASC and 14 typically developed adults. Identification of emotion from sentences in which the vocal emotion and the meaning of sentence were congruent was similar in people with ASC and a typically developed comparison group. However, the comparison group was more accurate at identifying the emotion in the voice from incongruent and neutral trials, and also from trials with no semantic content. The results of the vocal emotion task were correlated with performance on a face emotion recognition task. In decoding emotion from spoken utterances, individuals with ASC relied more on verbal semantics than did typically developed individuals, presumably as a strategy to compensate for their difficulties in using prosodic cues to recognize emotions.

BODY DYSMORPHIC DISORDER AND THE DSM-IV : THE DEMISE OF DYSMORPHOPHOBIA

To some extent, the failure of some authors, reporting on dysmorphophic patients, to specify clearly the level at which the belief is held, has confounded clarification of the phenomenon. Birtchnell (1) Dysmorphophobia is a controversial term. It is not a phobia, reliable data on it are few, and many authors write about it without attempting to define it. DSM-III-R introduced the term “body dysmorphic disorder” to describe a non-psychotic condition in which there is pathological preoccupation with physical appearance and with the intention of replacing the term “dysmorphophobia”. However, psychiatrists continue to use the word dysmorphophobia, often unaware that it may have several distinct meanings. This article, 1. demonstrates the current confusion in terminology, 2. elaborates on DSM-III-Rs concept of body dysmorphic disorder, and 3. suggests refinements for the DSM-IV description.

Investigating the Structure of the Autism-Spectrum Quotient Using Mokken Scaling

Traits similar to those shown in autism spectrum condition (ASC) are apparent in relatives of individuals with ASC, and in the general population without necessarily meeting diagnostic criteria for an ASC. We assess whether the Autism-Spectrum Quotient (AQ), a self-report measure, has hierarchical properties using Mokken scaling. Hierarchical scales allow the presence of a latent trait to be identified by discovering whether and how many specific items form an ordered array along it. Data were collected from 2 groups: (1) people with ASC (n = 449: 240 males, 209 females, M(age) 35.4 years, SD = 12.8) and (2) university students (n = 943: 465 males, 475 females, M(age) = 23.0 years, SD = 8.4). A single Mokken scale was obtained in the data from university students and 3 scales were obtained in the data from people with ASC. The scales all showed moderate Mokken scaling properties with the single scale obtained from university students showing weak invariant item ordering and 2 of the scales from people with ASC showing weak invariant item ordering. The AQ formed reliable Mokken scales. There was a large overlap between the scale from the university student sample and the sample with ASC, with the first scale, relating to social interaction, being almost identical. The present study confirms the utility of the AQ as a single instrument that can dimensionalize autistic traits in both university student and clinical samples of ASC, and confirms that items of the AQ are consistently ordered relative to one another.

Detecting the Dangerous, Violent or Criminal Patient: An analysis of referrals to maximum security psychiatric care

Britains high security hospitals provide care for mentally disordered patients who have dangerous, violent or criminal propensities. The State Hospital, Carstairs, takes referrals from the population of Scotland and Northern Ireland. This retrospective case-control study describes the sociodemographic and clinical characteristics of referrals (n=149) to the State Hospital during a 12-month period, and delineates differences between admitted (n=57) and rejected (n=92) patients. The referrals had an average age of 31.1 years, and were mostly male (86.6%), single (64.4%) and unemployed (90.6%). Admitted patients were more likely to have a criminal history, to be psychotic, to have a family history of mental disorder and to be viewed by the assessor as having psychotic beliefs which contributed to the behaviour or alleged offence leading to the referral. Rejected patients were more likely to have been remanded to prison or assessed by specialist registrars. Patients admitted to high security psychiatric care are more likely to show dangerous behaviour secondary to psychosis. These findings are in keeping with the requirements of mental health legislation and the admissions policy.

Autistic Traits and Sensitivity to Interference With Flavour Identification

We assessed whether autistic traits are related to the ability to identify flavour. In general, the colour of the food or drink facilitates identification of its flavour. In the current study, the colour of drinks either provided congruent, incongruent or ambiguous (colourless) information about the flavour. Participants identified the flavours of 12 drinks from a list and completed a measure of autistic traits, the Autism‐Spectrum Quotient (AQ). In line with previous studies, flavour identification was impaired in incongruent conditions, while identification in congruent conditions was not improved when compared with that in ambiguous conditions. AQ scores were related to flavour identification in incongruent conditions, in that as the AQ score increased, accuracy of flavour identification decreased. There were no relationships found in the congruent or ambiguous conditions. This finding is in line with the idea that conflicting sensory information may be more disruptive for individuals on the autism spectrum. Autism Res 2013, ●●: ●●–●●.