Overlap of identified neurotypes in a cohort of children referred for Autism assessment (n = 66).

The numbers in segments relate to the children identified with these specific neurotypes. n = 15 children were identified as only autistic. n = 2 were identified as having only a motor neurotype. n = 1 was identified as having only an ADHD like neurotype. All children identified as having a learning neurotype also had other neurotypes present. The numbers in each segment refer to children with more than one overlapping neurotype and reflect the corresponding overlaps.</p

Participant demographics.

BackgroundChildren’s health services in many countries are moving from single condition diagnostic silo assessments to considering neurodevelopment in a more holistic sense. There has been increasing recognition of the importance of clinical overlap and co-occurrence of different neurotypes when assessing neurodivergent children. Using a cross-sectional service evaluation design, we investigated the overlap of neurodivergences in a cohort of children referred for autism assessment, focusing on motor, learning, and attention/activity level domains. We aimed to determine what proportion of children in a cohort referred for an autism assessment showed traits of additional neurodivergences, and what proportion were further investigated.MethodsWe evaluated anonymised medical records of children aged between two and 17 years referred for autism assessment. We used validated questionnaires to assess for neurodivergent traits. A weighted scoring system was developed to determine traits in each neurodevelopmental domain and a score above the median was considered to indicate a neurodivergent trait. Evidence of further investigations were recorded. We then examined the relationships between autism traits and traits of additional neurodivergence.Results114 participants were included for evaluation. 62.3% (n = 71) had completed questionnaires for analysis. Of these, 71.8% (n = 51) scored greater than the median for at least one additional neurotype, indicating the presence of other neurodivergent traits, and 88.7% (n = 64) attracted a diagnosis of autism. Only 26.3% of children with evidence of additional neurotypes were further investigated beyond their autism assessment.ConclusionsOur results demonstrate the extensive overlap between additional neurodivergent traits in a population of children referred with suspected autism and show that only a small proportion were further investigated. The use of standardised questionnaires to uncover additional neurodivergences may have utility in improving the holistic nature of neurodevelopmental assessments.</div

STROBE statement—Checklist of items that should be included in reports of observational studies.

STROBE statement—Checklist of items that should be included in reports of observational studies.</p

Additional neurodivergent traits discovered by age and total for whole cohort.

Additional neurodivergent traits discovered by age and total for whole cohort.</p

Participant flow diagram.

Fig 1 shows the numbers (%) of referred children, with completed data, numbers (%) eventually diagnosed with autism and numbers (%) with evidence of additional neurodivergence.</p

Cortical activation for averted gaze.

<p>Statistical maps of differences in fMRI activation for CON>ASD for the contrast averted>direct gaze (depicted in red to yellow). Group differences reflect increased activation for averted gaze in CON and lack of activation in ASD. Statistical maps are displayed on the lateral, medial and ventral views of both hemispheres, at <i>p </i>_FWE <0.05. The light grey mask covers subcortical regions in which activity cannot be expressed in surface rendering.</p

Region of interest analysis.

<p>Percent BOLD signal change (± SEM), for averted vs. direct gaze in selected subcortical ROIs. The thalamus (THAL) (<i>p</i> = 0.01), and superior colliculus (SC) (<i>p</i> = 0.04) were significantly different between ASD and CON while a strong trend was found for the amygdala (AMY) (<i>p</i> = 0.056).</p

Between-group contrasts: CON>ASD for [AVERTED>DIRECT].

<p>Brain regions for which CON participants showed more activation than individuals with ASD for the contrast AVERTED>DIRECT, at <i>p</i>_FWE<0.05, <i>t</i>>3.2.</p

Within-group contrasts in CON.

<p>Brain regions for which CON showed increased activation for the contrast [AVERTED>DIRECT] gaze at <i>p</i>_FWE<0.05, <i>t</i>>3.2. CON did not show increased activation for [DIRECT>AVERTED] gaze.</p

Atypical reactivity to social stimuli in ASD.

<p>Individuals with ASD show increased response to direct as opposed to averted gaze ((1) - Kylliainen 2006) but show atypical eye contact. While deficits in fearful face processing have been described in ASD, no study to our knowledge has specifically investigated fearful vs. neutral faces and it is unclear if individuals with ASD would show more activation in response to direct fearful gaze as opposed to direct neutral gaze. Finally, unlike controls, individuals with ASD do not show more activation for fearful averted gaze.</p