Tuesday, March 2, 2021

Autistic Girls, Boys Differ in Social Communication

Autistic girls, boys differ in how they talk about social groups

During conversations, girls with autism use “we,” “they” and other words related to social groups differently than autistic boys do, according to a new study.

The findings could help parents and clinicians identify autism in girls, who tend to be diagnosed less often and later than boys, researchers say.

The failure to recognize autism in girls can put them at an increased risk of mental health problems such as anxiety, depression and suicidality.

“If girls with autism are not properly understood, then these girls may not get access to the proper resources they need early in life to get the support they need to flourish and reach their full potential,” says lead investigator Julia Parish-Morris, assistant professor of psychiatry at the University of Pennsylvania.

To gain insight into gender differences in problems with social communication — a core trait of autism — Parish-Morris and her colleagues analyzed how girls and boys with and without autism talk about other people during unscripted conversations.

“This is one of the few studies that have used natural language samples and not just responses to standardized tests to examine the difference in social interest between boys and girls with autism and typically developing boys and girls,” says Jenny Burton, a speech-language pathologist who was not involved with the study. It is also one of few studies to support the idea that, compared with autistic boys, girls with the condition have strengths in social interaction and motivation, she says.

Word search:

The scientists recorded audio and video as each participant took part in an informal five-minute ‘get to know you’ conversation with an undergraduate student or research assistant. The sample included 17 girls and 33 boys with autism, and 15 girls and 22 boys without the condition, all aged 8 to 17 and matched for age and intelligence quotient. They also matched the autistic children for levels of social impairment.

Computer programs transcribed the conversations and counted the number of plural personal pronouns — those that refer to groups of people, such as “we,” “us,” “they” and “them” — as well as words with social connotations, such as “family” and “friends.” The researchers then calculated how often a child used these words relative to the total number of words he or she said overall.

Autistic girls use plural personal pronouns almost twice as often as autistic boys do, and they use social words more often as well, the researchers found. The study was published in November in the Journal of Child Psychology and Psychiatry.

The findings may indicate that girls are “pressured to conform socially,” Parish-Morris says. “Pronouns can give hints about social embeddedness or the sense of social belonging, which matters with conditions with social challenges such as autism.”

The findings agree with previous research suggesting that autistic girls are more motivated to socialize than autistic boys — for instance, autistic girls tend to hover near other children on playgrounds, whereas autistic boys tend to play alone.

Autistic girls also use “they” and “them” more often than non-autistic girls do, the study found. Such heightened discussion of groups autistic girls are not members of may indicate they are aware of their social exclusion, the scientists note. “Saying ‘we did this and that’ is a very different frame of reference from saying ‘they did this or that,’” Parish-Morris says.

Not a monolith:

Overall, the study shows that autistic children and adolescents use significantly fewer plural personal pronouns than their non-autistic peers do. If the same pattern holds true for even younger children, diminished or atypical use of personal pronouns might prove useful to flag children for diagnosis, the researchers suggest.

The findings underscore the idea that “autism is not a monolith — it manifests differently across sexes and genders and ages and cultures,” Parish-Morris says.

As a next step, researchers could explore how autistic girls and boys differ when talking with other children instead of with adults.

Future studies could also analyze the specific socially connoted words autistic girls and boys use.

“It would be interesting knowing whether they are referencing family versus peers, due to potentially fewer social activities with peers and more time with family,” says Rene Jamison, associate professor of pediatrics at the University of Kansas in Kansas City, who did not take part in the new research. “In my research, we have found that when girls are in the 8 to 12 age range, both girls with and without autism would reference their family more than their peers, but as they grow older, we would expect girls without autism to shift to more external social groups, but girls with autism would not shift as much.”

           This article was published on Spectrum, the leading site for autism research news.

Monday, March 1, 2021

Co-Occurring ADHD in Autistic Children

Co-Occurring ADHD in Autistic Children

Interest in the co-occurrence of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) has grown in the last decade. Both are neurodevelopmental disorders with onset of symptoms in early childhood. Research, practice and theoretical models indicate that these disorders frequently overlap and co-occur. For example, studies conducted in the US and Europe indicate that children with ASD in clinical settings present with comorbid (co-occurring) symptoms of ADHD with rates ranging between 37% and 85%. In fact, ADHD is a relatively common initial diagnosis in young children with ASD. Some researchers suggest that there are sub-groups of children with ASD with and without ADHD symptoms.

More severe externalizing, internalizing and social problems, as well as more impaired adaptive functioning, and more autistic traits and maladaptive behaviors have been reported in children with both ASD and ADHD than children identified with only ASD. For example, school-age children with co-occurrence of ASD and ADHD were significantly more impaired than children with only ASD on measures of cognitive and social functioning, as well as in the ability to function in everyday situations. Symptoms included inattention, impulsivity, hyperactivity and other features such as low frustration tolerance, poor self-monitoring, temper and anger management problems, and mood changes in the classroom. They were also more likely to have significant cognitive delays and display more severe autism mannerisms, such as stereotypic and repetitive behaviors in comparison with children identified with only ASD.
It is imperative that practitioners recognize the high co-occurrence rates of these two disorders as well as the potential increased risk for social and adaptive impairment associated with comorbidity of ASD and ADHD. Children with the combined presence of ASD and ADHD may need different treatment methods or intensities than those with ASD only in order to achieve better outcomes.
If clinically significant ADHD symptoms are identified, and social development does not appear to be responding to intervention, changes in the intervention pro­gram (e.g. intensity, strategies, and goals) may be required. It is also important to note that a significant change in the DSM-5 is removal of the DSM-IV-TR hierarchical rules prohibiting the concurrent diagnosis of ASD and ADHD. When the criteria are met for both disorders, both diagnoses are given. Thus, an assessment of ADHD characteristics should be included whenever inattention and/or impulsivity are indicated as presenting problems. 

Although the social deficits of autism are typically described as being “reciprocal” in nature and those of ADHD are considered to be the result of inattention and disinhibition, the distinction is not always easy to make in real-world practice. In addition to rating scales, an examination of the child’s neuropsychological characteristics and profile may be helpful in identifying the comorbidity of ASD and ADHD. For example, a comprehensive developmental assessment may include measures of neuropsychological functions such as working memory, planning and strategy formation, cognitive flexibility, response inhibition, and self-regulation. More research is needed to further clarify the behavioral characteristics of children with co-occurring ASD and ADHD so that specialized treatments and interventions may be designed to improve outcomes and quality of life for this group of children. Further information on best practice guidelines for assessment of ASD is available from A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition)
Key References and Further Reading

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.) Washington, DC: Author.

Colombi, C., & Ghaziuddin, M. (2017). Neuropsychological Characteristics of Children with Mixed Autism and ADHD. Autism Research and Treatment, 1-5. 

Doepke, K. J., Banks, B. M., Mays, J. F., Toby, L. M., & Landau, S. (2014). Co-occurring emotional and behavior problems in children with Autism Spectrum Disorders. In L. Wilkinson (Ed.), Autism Spectrum Disorders in Children and Adolescence: Evidence-based Assessment and Intervention in Schools (pp. 125-148). Washington, DC: American Psychological Association.

Kuhlthau K., Orlich F., Hall T.A., et al. (2010). Health- Related Quality of Life in children with autism spectrum disorders: results from the autism treatment network. Journal of Autism and Developmental Disorders, 40(6), 721–729.

Loveland K. A., Tunali-Kotoski, B. (2005), The school age child with autism. In F. R. Volkmar, R. Paul, A. Klin, & D. Cohen (Eds.), Handbook of autism and pervasive developmental disorders: Vol. 1. Diagnosis, development, neurobiology, and behavior (3rd ed., pp. 247-287). New York: Wiley.

Murray M.J., (2010). Attention-deficit/hyperactivity disorder in the context of autism spectrum disorders. Current Psychiatry Reports, 12(5), 382–388.

Rao, P. A., & and Landa, R. J. (2014). Association between severity of behavioral phenotype and comorbid attention deficit hyperactivity symptoms in children with autism spectrum disorders. Autism, 18, 272-280.

Sikora, D. M., Vora, P., Coury, D. L., & Rosenberg, D. (2012). Attention-Deficit/Hyperactivity Disorder Symptoms, Adaptive Functioning, and Quality of Life in Children With Autism Spectrum Disorder. Pediatrics, 130, S91-97. DOI: 10.1542/peds.2012-0900G
Wilkinson, L. A. (2017). A best practice guide to assessment and intervention for autism spectrum disorder in schools. London & Philadelphia: Jessica Kingsley Publishers.

Lee A. Wilkinson, PhD, is a licensed and nationally certified school psychologist, and certified cognitive-behavioral therapist. He is author of the award-winning books,  A Best Practice Guide to Assessment and Intervention for Autism and Asperger Syndrome in Schools and Overcoming Anxiety and Depression on the Autism Spectrum: A Self-Help Guide Using CBTHe is also editor of a text in the APA School Psychology Book Series, Autism Spectrum Disorder in Children and Adolescents: Evidence-Based Assessment and Intervention in Schools. His latest book is A Best Practice Guide to Assessment and Intervention for Autism Spectrum Disorder in Schools (2nd Edition).

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