Autism in Adults in Romania: Challenges in Diagnosis and Screening

Obsessive-compulsive disorder (OCD) affects 1-3% of children and adolescents. Although a close relation between OCD and autism spectrum disorder (ASD) has been pointed out, the relation between maternal ASD symptoms and subclinical ASD symptoms in OCD have not been evaluated adequately. In this study, children and adolescents with OCD diagnosis, and OSB indications in their mothers were investigated. The relationship between the clinical severity of these indications in children and adolescents with OCD, and maternal OSB indications will be examined. The study group consisted of 38 cases (8-18 years old) diagnosed with OCD. The control group (n=39) comprised patients of other clinics at hospital, and was matched for gender and age to the OCD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL) was used to diagnose OCD and accompanying comorbidities. Social Communication Questionnaire (SCQ) was used to evaluate children's ASD symptoms while Autism Spectrum Quotient (ASQ) was used to evaluate maternal broad autism phenotype. OCD symptoms in children were evaluated with Children Yale-Brown Obsessive Compulsive Scale-(C-Y-BOCS), and OCD symptoms in mothers were evaluated with Yale-Brown Obsessive Compulsive Scale-(Y-BOCS). There was no significant difference between sociodemographic data of two groups. When cases and controls were compared with SCQ; all subscales' scores and total score of SCQ were statistically significant higher in OCD group and also mothers of OCD group had statistically significant higher scores in total score of ASQ and subscales except "imagination". Also in comparing the groups with Y-BOCS and C-Y-BOCS; OCD group had statistically significant higher scores in these scales. ASD symptoms are prevalent in cases diagnosed with OCD and ASD symptoms increases with OCD severity. Further studies are needed to examine genetic and environmental common risk factors between OCD and ASD.

Autism Spectrum Disorder (ASD) are life-long conditions characterised by socio-communication deficits and stereotyped behaviours (American Psychiatric Association, 2013). To date, little is known about experiences of adults living with ASD, especially for those who manage to develop couple relationships and become parents (Howlin & Moss, 2012). This research examines the associations between self-perceived traits of autism and marital quality, parenting sense of competency and anxiety symptoms in adults affected by ASD. Uniquely, the sample encompasses 1) adults diagnosed with ASD whose children also have diagnosis of ASD; 2) non-ASD diagnosed parents who have children diagnosed with ASD and; 3) non-ASD parents who have typically developing children. Parents of children diagnosed with ASD are particularly targeted for their susceptibility to tendency towards autism (Bernier, Gerdts, Munson, Dawson, & Estes, 2011), and their distinctively high prevalence of psychiatric illness and marital breakdowns (Benson & Kersh, 2011; Hayes & Watson, 2013). Effects of child versus parental traits of autism were considered simultaneously. The thesis entails five empirical studies of which four have been published in peer-reviewed journals and one currently under review. Study 1 (chapter 5) investigated the associations between adult attachment style, marital quality and parenting satisfaction in adults formally diagnosed with Asperger’s Disorder/Asperger’s Syndrome (AS; a higher functioning variant of ASD). Strikingly, as high as 82% of this group reported insecure adult attachment style as opposed to 22% of non-ASD controls. Interestingly no association between insecure attachment style and marital dissatisfaction was found in the AS group, and their marital satisfaction did not differ from the non-ASD controls. Diagnosis of AS in child, but not in parent, was associated with parenting satisfaction. Study 2 (chapter 6) advanced the research by exploring the link between parental self-perceived traits of autism and parenting sense of efficacy in a significantly large sample of Australian parents (n=346). Interestingly, nearly half (47%) of the parents diagnosed with ASD rated themselves below the recommended diagnostic cut-off on the Autism Spectrum Quotient (AQ) whereas about 20% of the non-diagnosed parents of children with ASD scored above the cut-off on the AQ. Low parenting sense of efficacy was noted in undiagnosed mothers who scored highly on the AQ and in fathers who had formal diagnosis of ASD. These findings highlighted the importance of measuring traits of autism in parents of children with ASD and called for a reliable tool for this purpose. Thus Study 3 and Study 4 were devoted to test factorial solutions for the AQ. Study 3 (chapter 7) was based on data from 455 Australian adults of whom 141 had clinical diagnosis of ASD. Study 4 (chapter 8) drew from 4,192 Taiwanese parents of whom 1,208 had children with ASD. Each study resulted in a factor model (AQ-39 and AQ-Chinese respectively) that demonstrated significantly improved goodness of fit than previously published factorial solutions for the AQ. The AQ was found to have consistent reliability across non-clinical and clinical populations, was culturally robust and its constructs corresponded with the current diagnostic taxonomy of ASD. The AQ-Chinese was the first AQ factorial solution tailored to the Mandarin-speaking community. Study 5 (chapter 9) employed the AQ-Chinese to test the link between self-perceived traits of autism and anxiety symptoms in 491 Taiwanese couples raising children with ASD. Unique to this study were its couple-centred approach and its inclusion of all anxiety domains. Large effect sizes were found in social phobia and post traumatic stress disorders for both genders, and in general anxiety disorder and agoraphobia for female. These associations were irrespective of child’s tendency towards autism, spouse’s AQ scores and the couples’ compatibility in their tendency towards autism. Findings from this research offer imperative theoretical and clinical implications in regard to broad autism phenotype in parents of children with ASD, parenting training and couple counselling approaches for adults with ASD, effects of child versus parental traits of autism on parental psychosocial functioning, cultural influence in autism, screening and diagnosing ASD in adults who are high functioning and research and clinical utility of the AQ.

Why physically active people report lower anxiety than those who are inactive is not well understood. This study examined whether physical self-concept and self-esteem would mediate associations of self-reported physical activity with anxiety disorder symptoms in young women, a population with elevated risk for developing an anxiety disorder. College women (N = 1036, mean ± SD = 19.7 ± 2.9 yr) completed a physical activity recall, the Psychiatric Diagnostic Screening Questionnaire, and the Physical Self-Description Questionnaire. Structural equation modeling was used to test hypotheses. Physical activity had inverse, indirect associations with symptoms of social phobia, generalized anxiety disorder, and obsessive-compulsive disorder that were expressed through its positive association with specific and global physical self-concept and self-esteem. The results were independent of similar relations with symptoms of major depressive disorder as well as the estimates of body fatness and use of psychotropic medications. These correlational findings provide initial evidence to warrant experimental efficacy trials of whether physical activity will reduce the risk of anxiety disorders in young women by positive influences on physical self-concept and self-esteem.

Improving social cognition and skills in adult ASD: a tDCS pilot study

The diagnosis of Autism Spectrum Disorder (ASD) can be difficult to achieve, especially since the diagnostic criteria have changed in the last decade. This challenge is even greater for Romanian clinicians, as there are currently no screening tools validated for diagnosing ASD in adults within the Romanian population. This study aims to validate two screening instruments used to identify autistic traits in the Romanian general population: the Autism Spectrum Quotient (AQ) and the Empathy Quotient (EQ). Data was collected by administering the Romanian version of the scales to a sample of 916 Romanian native speakers from the non-clinical population. 108 individuals were re-tested after 2 years. The scales were validated by determining their reliability with respect to the stability of the results and evaluating their construct and structural validity in correlation with the following instruments: QCAE (Questionnaire of Cognitive and Affective Empathy), PAQ (Perth Alexithymia Questionnaire) and BVAQ (Bermond-Vorst Alexithymia Questionnaire). Our data revealed that, regarding reliability, the Romanian version of AQ presents slightly lower internal consistency compared to the original validation study. Concerning structural validity, confirmatory factor analysis (CFA) revealed suboptimal fit indices for the original 5-factor structure. Based on a subsequent exploratory factor analysis (EFA), a 2-factor solution returned improved fit indices. Despite employing more items to measure the constructs than needed, this study confirmed that both instruments present a valuable resource for clinicians working with neurodivergent patients, as interest in this area of pathology has increased greatly in Romania over the past few years. Practical implications and methodological issues regarding the two instruments are discussed.

AUTISTIC SPECTRUM DISORDER IN ADULTS WITH OBSESSIVE COMPULSIVE DISORDER: RESULTS FROM A UK SURVEY

BackgroundThe Autism-Spectrum Quotient (AQ) is widely used to quantify autistic traits, which have been evaluated in the parents of individuals with autism spectrum disorders (ASD) and in the general population. This paper’s objective was to investigate the AQ's psychometric properties of the Chinese version for mainland China and to establish whether the pattern of sex differences in the quantity of autistic traits exists. We also examined the usefulness of the AQ in differentiating between individuals with ASD, schizophrenia (SCH), obsessive-compulsive disorder (OCD) and healthy controls (HC).MethodsIn this study, the psychometric properties of the AQ were assessed in 1037 parents of children with ASD and in 1040 parents of typically developing children (TDC). Additionally, 32 participants with ASD, 37 patients with SCH, 38 OCD patients and 38 healthy controls (matched for age, gender and IQ) were assessed with the AQ.ResultsThe internal consistency and test-retest reliability of the AQ and AQ subscales were within an acceptable range. Parents of ASD children scored higher than TDC parents on total AQ and AQ subscales, and TDC parents scored more than parents of ASD children on 2 items of 50. Fathers scored higher than did mothers on total AQ and four subscales, with the sole exception being the subscale attention to detail. The total AQ score of the ASD group was higher than that of the SCH, OCD and HC groups, and the total AQ score of the HC group was significantly lower than that of the SCH and OCD groups, with no differences being observed between the SCH and OCD groups.ConclusionsThe Mandarin AQ demonstrated promising psychometric properties and was a reliable instrument for quantifying autistic traits in both clinical and non-clinical samples in mainland China.

Objectives: Patients with obsessive compulsive disorder (OCD) frequently show traits of autism spectrum disorders (ASD). This is one of the first studies to explore the clinical impact of the overlap between OCD and ASD as a categorical diagnosis.Methods: A cross-sectional survey in 73 adult outpatients with DSM-IV OCD. Autistic traits were measured using the Autism-Spectrum Quotient (AQ). A clinical estimate ASD diagnosis was made by interview using DSM-IV-TR criteria. OCD patients with and without autistic traits or ASD were compared on demographic and clinical parameters and level of OCD treatment-resistance based on treatment history.Results: Thirty-four (47%) patients scored above the clinical threshold on the AQ (≥26) and 21 (27.8%) met diagnostic criteria for ASD. These diagnoses had not been made before. Patients with autistic traits showed a borderline significant increase in OCD symptom-severity (Yale-Brown Obsessive Compulsive Scale (Y-BOCS); p = .054) and significantly increased impairment of insight (Brown Assessment of Beliefs Scale; p = .01). There was a positive correlation between AQ and Y-BOCS scores (p = .04), but not with OCD treatment resistance.Conclusion: There is a high prevalence of previously undiagnosed ASD in patients with OCD. ASD traits are associated with greater OCD symptom-severity and poor insight.

Background: Previous research has questioned the validity of diagnostic measures for autism spectrum disorder (ASD) among adults. This study examined the correspondence between several measures and...

Introduction: Autism spectrum disorder (ASD) describes a group of disorders characterised by deficits in communication and social interactions. Gastrointestinal (GI) symptoms including abdominal pain and constipation frequently occur with ASD. Treatments that modulate the gut microbiota including antibiotics and fecal microbiota transplantation (FMT) have shown promise in the treatment of children with ASD and GI symptoms. However, these findings have not yet been reported in adults. Case description/methods: The male patient (16yrs) was referred for assessment of severe, supra umbilical abdominal pain, slow bowel function and straining on defecation. The patient had been diagnosed with ASD at age 4. The patient was prescribed off label Vancomycin and Rifaximin (Table 1). Review at one month indicated improvements in bowel frequency and consistency, although abdominal pain persisted. Improvements in mental state were also reported including increased engagement in family activities and being calmer in nature. Addition of Tinidazole reduced abdominal pain and further improved organisational skills and collaborative work at school. The patient was referred for trial of Ultra-Filtrate (UF) FMT at aged 21yrs. UF FMT was produced using screened donor stool, which was homogenised with saline, passed through multiple sieves of decreasing size and centrifuged. Antibiotics were ceased and the UF was taken orally in home-made ice-cream. The patient completed a quality assessment form including taste and smell for the UF, an abdominal symptom questionnaire, Autism Spectrum Quotient (ASQ) questionnaire and Cambridge Behaviour Scale (empathy quotient) scores (CBS) at pre-FMT and week 14. The patient reported a very mild taste from the UF but that it was easy to take with an increase in flatulence in the first two weeks of treatment. No other adverse side effects were reported. At week 14 the patient reported bowel motions 1-2 times daily and no abdominal pain. A 4-point reduction in ASQ score and a 7-point increase in CBS was observed (Fig. 1). Discussion: To our knowledge, this is the first report of the use of antibiotics followed by UF FMT to treat GI symptoms and ASD in an adult patient. Combination antibiotics was effective in reducing abdominal pain and resolving constipation. Improvements in autistic traits were seen with antibiotic treatment. Follow on treatment with UF FMT further resolved abdominal pain and continued improvement in autistic traits were observedTable 1.: Summary of treatment regimen for adult male patient with GI symptoms and ASD BD: twice a day, TID: three times a day, mane: morning, nocte: evening, BO: bowels open, mg: milligram, Tx: Treatment regimen.Figure 1.: Change in ASD scores before and after treatment with Ultra-Filtered FMT (a) Change in Autism Spectrum Quotient (ASQ) score before and after treatment with ultra filtered FMT. A score of ≥32 is considered to indicate clinically significant ASD traits (b) Change in Cambridge Behaviour Score (CBS) before and after treatment with ultrafiltered FMT. A score of ≤20 indicates a lower than average ability for understanding how other people feel and responding appropriately and is associated with ASD..

Autistic spectrum disorder (ASD) is an increasingly recognised neurodevelopmental condition; that is, a neurologically-based condition which interferes with the acquisition, retention or application of specific skills. ASD is characterised by challenges with socialisation and communication, and by stereotyped and repetitive behaviours. A stereotyped behaviour is one which is repeated over and over again and which seems not to have any useful function. ASD often co-occurs with mental health disorders, including obsessive compulsive disorder (OCD). People with ASD may show certain cognitive differences (i.e. differences in ways of thinking) which influence their response to therapies. Thus, there is a need for evidence-based guidelines to treat mental health issues in this group. OCD,a common condition characterised by repeated obsessional thoughts and compulsive acts, occurs with greater frequency in persons with ASD than in the general population. Genetic, anatomic, neurobiologicaland psychological factors have been proposed to explain this co-occurrence. However, care should be taken to distinguish stereotyped and repetitive behaviours characteristic of ASD from obsessive compulsive acts in OCD. Cognitive behavioural therapy (CBT) is the recommended treatment for OCD, but studies have suggested that this treatment may be less effective in those with OCD co-occurring with ASD. Hence, modifications to CBT treatment may be helpful when treating OCD co-occurring with ASD to optimise outcomes. To assess the effectiveness of behavioural and cognitive behavioural therapy for obsessive compulsive disorder (OCD) in children and adults with autism spectrum disorder (ASD). We searched for studies in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, PsycINFO, five other bibliographic databases, international trial registries and other sources of grey literature (to 24 August 2020). We checked the reference lists of included studies and relevant systematic reviews to identify additional studies missed from the original electronic searches. We contacted subject experts for further information when needed. We included randomised controlled trials (RCTs), cross-over, cluster- and quasi-randomised controlled trials involving both adults and children with diagnoses of OCD and ASD. We included studies of participants with co-occurring conditions (i.e. those experiencing other mental illnesses or neurodevelopmental conditions at the same time), but we did not include individuals who had a co-occurring global learning difficulty. Treatment could be in any setting or format and include behavioural therapy (BT) and cognitive behavioural therapy (CBT), which may have been adapted for those with ASD. Comparator interventions included no treatment, waiting list, attention placebo (where the control group receives non-specific aspects of therapy, but not the active ingredient) and treatment as usual (TAU, where the control group receives the usual treatment, according to accepted standards). Three review authors independently screened studies for inclusion. The authors extracted relevant data from the one eligible study, assessed the risk of bias and certainty of evidence (GRADE). Outcomes of interest were changes in OCD symptoms and treatment completion (primary outcome), and severity of depressive symptoms, anxiety symptoms and behavioural difficulties, as well as degree of family accommodation (secondary outcomes). We did not conduct meta-analyses as only one study met the selection criteria. We included only one RCT of 46 participants in our analysis. This study compared CBT for OCD in persons with high-functioning ASD with a control group who received anxiety management only. There were no differences in rates of treatment completion between the CBT (87%) and anxiety management (87%) groups (risk ratio (RR) 1.00, 95% confidence interval (CI) 0.80 to 1.25; low-certainty evidence). Behavioural difficulties were not included as an outcome measure in the study.This study showed that there may be a benefit at the end of treatment favouring CBT compared with anxiety management in OCD symptoms (mean difference (MD) -3.00, 95% CI -8.02 to 2.02), depression symptoms (MD -1.80, 95% CI -11.50 to 7.90), anxiety symptoms (MD -3.20, 95% CI -11.38 to 4.98), and quality of life (MD 5.20, 95% CI -1.41 to 11.81), but the evidence was of low certainty. AUTHORS' CONCLUSIONS: Evidence is limited regarding the efficacy of CBT for treatment of OCD in ASD. There is much scope for future study, not only examining the efficacy of CBT for OCD in ASD, but also the particular ways that OCD manifests in and affects people with ASD and the role of the family in treatment response.

Obsessive Compulsive Disorder (OCD) and Autism Spectrum Disorder (ASD) have similar characteristics. People with one of these disorders are more likely to meet the diagnosis of the other disorder than the general population. This study mainly investigated whether autistic traits predicted obsessive-compulsive symptom subtypes after controlling for some demographic features and clinical variables. This study included 460 university students from two universities and their family members. The subjects were asked to complete a sociodemographic and clinical data form, the Vancouver Obsessional Compulsive Inventory (VOCI), the Autism-Spectrum Quotient (AQ), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The relationship between autistic symptoms and obsessive-compulsive symptoms was assessed using linear regression analysis, controlling for age, sex, depression, anxiety scores, and a history of frequent childhood upper respiratory tract infections (URTIs). The AQ attention-switching score was associated with hoarding (β = 0.135, p = .002), just-right (β = 0.087, p = .026), indecisiveness (β = 0.101, p = .006), and total VOCI (β = 0.080, p = .038) score. AQ subscale scores other than attention-switching were not associated with VOCI scores. Age was negatively associated with obsessions (β = -0.133, p = .001), just-right (β = -0.129, p = .002), indecisiveness (β = -0.214, p < .001), and total VOCI score (β = -0.109, p = .006). BDI and BAI total scores were positively associated with all VOCI scores (all β in between 0.114 and 0.318, all p in between 0.033 and <0.001). Checking (p = .025), just-right (p = .038), and total VOCI scores (p = .046) were significantly higher in the group with a history of frequent childhood URTIs compared to the group without. Individuals with OCD symptoms may exhibit attention-switching deficits similar to those of individuals with ASD symptoms, suggesting a subgroup of OCD that shares features with ASD. Attention-switching deficits should be further investigated in terms of the relationship between ASD and OCD.

Assessing Diverse Students With Autism Spectrum Disorders

BackgroundTo diagnose and manage adults with Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), or their co-occurrence (ADHD + ASD), clinicians must identify specific features that differentiate these diagnostic categories. Self-report questionnaires targeting specific features are widely used and, together with clinical assessments, provide reliable diagnoses. Although affective lability is present in various psychiatric disorders, it lacks specificity when screening for ADHD in the general population, and its discriminant value for ADHD, ASD, and ADHD + ASD has not been studied.MethodsThis study involved 300 adults without intellectual developmental disorder (188 male) who received an ADHD (n = 174), ASD (n = 68), or ADHD + ASD (n = 58) diagnosis after a multidisciplinary consensus decision according to DSM-5 criteria. Before clinical assessment, all patients requesting evaluation for one of these diagnoses completed questionnaires on an online platform. The assessment instruments included a modified version of the Barkley Adult ADHD Rating Scale (BAARS IV) for ADHD, the Autism Spectrum Quotient (AQ) and the Empathy Quotient (EQ) for ASD features, and the Affective Lability Scale (ALS) for affective lability. Total scores and sub-scores of the instruments were compared among the three groups. Additionally, stepwise logistic regression analyses were conducted to identify specific measures that contribute to group discrimination.ResultsResults revealed distinct patterns in symptomatology as expected. The ADHD and the ADHD + ASD groups presented significantly higher ALS total score compared to ASD. Stepwise logistic regression analyses identified specific measures contributing to group differentiation. ASD vs. ADHD + ASD discrimination included BAARS IV current total score and EQ total score. The subscale anger from ALS in addition with BAARS IV past total score and AQ total score were the factors that discriminated ADHD diagnosis from the co-occurrence of ADHD and ASD. Finally, BAARS IV past total score, BAARS IV current inattention, AQ total score, and EQ total score were found to differentiate ADHD from ASD.ConclusionsThe study highlights the significance of incorporating emotional dimensions in diagnostic frameworks and may contribute valuable insights for clinicians differentiating neurodevelopmental conditions.

Assessment of cognitive profile (WISC-IV), autistic symptomatology and pragmatic disorders in high intellectual potential compared with autism spectrum disorder