Abstract

Social skills group training (SSGT) is a frequently used behavioral intervention in autism spectrum disorder (ASD), but the effects are moderate and heterogeneous. Here, we analyzed the effect of polygenic risk score (PRS) and common variants in gene sets on the intervention outcome. Participants from the largest randomized clinical trial of SSGT in ASD to date were selected (N = 188, 99 from SSGT, 89 from standard care) to calculate association between the outcomes in the SSGT trial and PRSs for ASD, attention-deficit hyperactivity disorder (ADHD), and educational attainment. In addition, specific gene sets were selected to evaluate their role on intervention outcomes. Among all participants in the trial, higher PRS for ADHD was associated with significant improvement in the outcome measure, the parental-rated Social Responsiveness Scale. The significant association was due to better outcomes in the standard care group for individuals with higher PRS for ADHD (post-intervention: β = −4.747, P = 0.0129; follow-up: β = −5.309, P = 0.0083). However, when contrasting the SSGT and standard care group, an inferior outcome in the SSGT group was associated with higher ADHD PRS at follow-up (β = 6.67, P = 0.016). Five gene sets within the synaptic category showed a nominal association with reduced response to interventions. We provide preliminary evidence that genetic liability calculated from common variants could influence the intervention outcomes. In the future, larger cohorts should be used to investigate how genetic contribution affects individual response to ASD interventions.

Highlights

  • The response to behavioral interventions varies between individuals with the same neurodevelopmental and psychiatric disorders

  • Genetic variations in genes underlying glutamatergic or NMDA neurotransmission have been implicated in short-term antipsychotic medication efficacy in schizophrenia, and the calcium signaling pathway has been indicated to respond to selective serotonin reuptake inhibitors in obsessive-compulsive disorder[10,12]

  • We recently showed that autistic individuals who were carriers of clinically significant and rare genic copy number variations (CNVs) larger than 500 kb had significantly inferior outcomes after skills group training (SSGT) within the RCT27

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Summary

Introduction

The response to behavioral interventions varies between individuals with the same neurodevelopmental and psychiatric disorders. Genome-wide association studies (GWAS) have been used to pinpoint common variants, with mostly small effects, associated with disorders or personality traits across the genome. The use of polygenic risk score (PRS), an aggregate measure of the cumulative effects of single nucleotide polymorphisms (SNPs) derived from GWAS, has provided promising results in psychiatry both for behavioral and pharmacological treatments[3,4,5,6,7]. PRS has been studied to predict the response to cognitive behavior therapy in major depressive disorder (MDD)[4]. In addition to PRS, gene-set analysis can be utilized to group multiple genetic variants in genes and further to related gene sets to unravel biological processes and cellular functions related to intervention responses[8]. Relevant gene-set associations have been identified for interventions in psychiatry[8,9,10,11,12]. Genetic variations in genes underlying glutamatergic or NMDA neurotransmission have been implicated in short-term antipsychotic medication efficacy in schizophrenia, and the calcium signaling pathway has been indicated to respond to selective serotonin reuptake inhibitors in obsessive-compulsive disorder[10,12]

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