Abstract

Germline heterozygous PTEN mutations have been associated with high prevalence of autism spectrum disorder (ASD) and elevated rates and severity of broadly defined behavioral problems. However, limited progress has been made toward understanding whether PTEN mutation is associated with specific psychiatric co-morbidity profiles when compared to idiopathic ASD. The current study aimed to utilize a cross-measure approach to compare concurrent psychiatric characteristics across children and adolescents with PTEN mutation with (PTEN-ASD; n = 38) and without ASD (PTEN-No ASD; n = 23), and ASD with macrocephaly but no PTEN mutation (macro-ASD; n = 25) using the Child Behavior Checklist (CBCL) and the Aberrant Behavior Checklist (ABC). There were significant group effects for the CBCL Internalizing and Externalizing broad symptom score, the majority of specific CBCL syndrome scores, and all ABC subscale scores. Post-hoc comparisons revealed greater behavioral symptoms in the ASD groups (PTEN-ASD and macro-ASD) compared to the PTEN-no ASD group on nearly all subtest scores examined. There were no statistically significant differences between the PTEN-ASD and macro-ASD groups; however, there was a trend for the macro-ASD group showing higher levels of aggressive behaviors. Our findings provide evidence of specific behavior profiles across PTEN-No ASD, PTEN-ASD, and macro-ASD groups and highlight the importance of early identification of behavioral vulnerabilities in individuals with PTEN mutations in order to provide access to appropriate evidence-based interventions.

Highlights

  • Germline mutations in the gene encoding phosphatase and tensin homolog tumor suppressor (PTEN) result in a range of physical, behavioral and cognitive features including macrocephaly, executive functioning deficits, elevated rates of intellectual disability and high prevalence of autism spectrum disorder (ASD) [1,2,3,4]

  • Regardless of age, at least 23% of individuals with PTEN mutations meet DSM-5 diagnostic criteria for ASD [3, 9, 10], and research has started to explore whether individuals with PTEN mutations differ in terms of presentation and severity of core ASD symptoms from individuals with idiopathic ASD [2, 11]

  • In the PTEN-no ASD group, 30.4 and 21.7% of participants scored in the clinical range for Internalizing and Externalizing symptoms, respectively

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Summary

Introduction

Germline mutations in the gene encoding phosphatase and tensin homolog tumor suppressor (PTEN) result in a range of physical, behavioral and cognitive features including macrocephaly, executive functioning deficits, elevated rates of intellectual disability and high prevalence of autism spectrum disorder (ASD) [1,2,3,4]. Clinical presentations in a study of nine patients with PHTS ranged from asymptomatic macrocephaly to clinical diagnosis of anxiety, bipolar disorder, obsessive-compulsive disorder (OCD), psychosis and adult-onset movement disorder [13]. Another retrospective chart review of 47 patients aged between 1 and 26 years of age showed that apart from ASD diagnosis, which was found in 50% of individuals, 34% of the cohort had at least one behavioral/psychological diagnosis with ADHD (24%) and anxiety (15%) being the most common [3]

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