Autismi naisilla

Tutkimuksen tausta ja tarkoitus: Autismi on kehityksellinen neuropsykiatrinen häiriö, jonka keskeisiä oireita ovat vaikeudet sosiaalisessa vuorovaikutuksessa ja kommunikaatiossa sekä toistava ja rajoittunut käyttäytyminen ja kiinnostuksen kohteet. Autismi on noin 2-5 kertaa yleisempi miehillä kuin naisilla. Viime vuosina on huomattu, että autismi voi ilmetä hieman eri tavoin naisilla kuin miehillä. Tämän systemaattisen katsauksen tarkoitus oli muodostaa kattava kokonaiskuva autismista naisilla, minkä vuoksi tutkimus kattoi seuraavat autismin osa-alueet: oireet, liitännäisongelmat, neuropsykologiset piirteet, neurobiologian, neurogenetiikan ja neuroendokrinolgian. Tutkimuskysymykset olivat seuraavat: 1) Onko autismin kliininen kuva naisilla erilainen kuin miehillä? 2) Onko autismin etiologiasta löydettävissä sellaisia eroja naisten ja miesten välillä, mitkä voivat selittää sukupuolivinoumaa? 3) Onko sukupuolivinoumaa selittäville tekijöille löydettävissä todisteita ja onko selityksiä mahdollista yhdistää yhdeksi kokoavaksi teoriaksi? Lisäksi tarkoitus on muodostaa malli, joka kokoaa aikaisemmat teoriat yhdeksi kokonaisuudeksi. Menetelmät: Tutkimus toteutettiin systemaattisena katsauksena, jossa seurattiin PRISMA-ohjetta soveltuvin osin. Katsaukseen valittavien artikkelien kriteerit ja käytetyt hakusanat määriteltiin niin, että tuloksena saataisiin mahdollisimman kattavasti artikkeleita, joissa käsitellään tutkimuksen aiheita. Artikkeleita haettiin PsycINFO- ja MedLine-tietokannoista. Kriteerit täyttäviä artikkeleita löytyi yhteensä 129 kappaletta. Artikkeleista kerättiin tutkimuksen kannalta oleelliset tiedot, joita olivat osallistujien määrä, ikä, sukupuoli ja diagnoosityyppi, käytetyt menetelmät ja tulokset. Tulokset: Sukupuolieroja löytyi kaikilta tutkimuksen kohteena olevilta alueilta. Autismikirjon naisilla, joilla on normaali kognitiivinen kapasiteetti, on havaittu olevan vähemmän vaikeuksia sosiaalisissa tilanteissa sekä vähemmän toistavaa ja rajoittunutta käyttäytymistä ja kiinnostuksenkohteita kuin autismikirjon miehillä. Lisäksi heillä todettu olevan paremmat kielelliset taidot kuin autismikirjon miehillä. Poikkeavuuksia aistiärsykkeiden prosessoinnissa autismikirjon naisilla on sen sijaan löydetty enemmän kuin autismikirjon miehillä. Autismikirjon naisilla on havaittu myös olevan enemmän mielenterveyden ongelmia ja epilepsiaa kuin autismikirjon miehillä. Lisäksi autismikirjon naisilla on havaittu olevan matalampi kognitiivinen peruskapasiteetti kuin autismikirjon miehillä. Etiologian osalta sukupuolieroja on löydetty neuroanatomiasta, alttiusgeeneistä ja hormonitasoista. Johtopäätökset: Tutkimustulokset viittaavat siihen, että autismia ei tunnisteta naisilla riittävän hyvin. Syynä tähän ovat sukupuolierot autismin etiologiassa, jotka ovat johtaneet siihen, että autismin oirekuva on osittain erilainen miehillä ja naisilla. Autismitutkimus on myös keskittynyt pääasiassa autismikirjon miehiin. Alidiagnosoinnilla on monia negatiivisia seurauksia autismikirjon naisille, koska ilman diagnoosia he eivät saa tarvitsemaansa tukea. Tulevaisuudessa on erityisen tärkeää kiinnittää sekä tutkimuksessa että kliinisessä työssä huomiota myös autisminkirjon naisiin.Background and objectives: Autism spectrum disorders (ASD) are developmental neuropsychiatric disorders in which core symptoms are problems in communication and interaction as well as restrictive and repetitive behaviour and interests. ASD is 2-5 times more common in males than in females. In recent years, researchers have found, that there are differences between females and males in ASD symptoms, neuropsychological characteristics, comorbid problems, neurobiology and etiology. The purpose of this systematic review is to give a comprehensive picture about the role of female sex/gender in ASD. To establish this, the review covers symptoms of autism, neuropsychology, neurobiology, comorbidity, neurogenetics and neuroendocrinology. Research questions were the following: 1) Is there evidence of sex/gender differences in ASD symptoms and comorbidity disorders? 2) Are there sex/gender differences to be found in ASD etiology? 3) What kind of support different explanations about sex/gender bias have gotten in various research areas? The purpose of the study is also to integrate the existing theories into one model that takes account to different aspects of sex/gender differences in ASD. Methods: The protocol of this systematic review follows "The Preferred Reporting Items for Systematic Reviews and Meta-Analyses" (PRISMA) when applicable. Eligibly criteria and search terms were selected in a way that would offer the widest range of articles covering the subjects of this study. Literature search was conducted using the Medline and PsychINFO as search engines. The final sample consisted of a total of 129 articles. Data was extracted on all relevant variables of the study, that were the number of participants, age of participants, specific diagnoses, methods and results. Results: Sex/gender differences in ASD were found in all areas that were included in this systematic review. Females with high function ASD (HFASD) were found to have less problems in social communication and interaction and less repetitive and restricted behavior and interests than males with HFASD. In addition, HFASD were found to have better language skills than males with HFASD. However, females with ASD were found to have more sensory processing problems, mental health problems and epilepsy than males with ASD. Females with ASD were also found to have lower full-scale intelligence quotient than males with ASD. In the context of etiology, it has been found that there are sex/gender differences in neuroanatomy, susceptibility genes and hormone levels. Conclusions: Results from this systematic review suggest that females with HFASD are underdiagnosed. This results from etiological sex/gender differences that cause partially different clinical presentation of ASD between females and males. ASD research has also concentrated mostly on males with ASD while ignoring females with ASD. Underdiagnosing can have many unfavorable consequences for females with HFASD since if they do not have a diagnosis, they do not get support. In the future, it is crucial to pay attention to females with ASD in the clinical work and scientific research

Atypical sensory processing is associated with lower body mass index and increased eating disturbance in individuals with anorexia nervosa

Background:Elevated autism spectrum disorder (ASD) traits are associated with anorexia nervosa (AN). Conversely, eating disturbances, which are core characteristics of AN, are common in ASD. Among individuals with ASD, atypical sensory processing is associated with eating disturbance. Because AN and ASD appear to overlap, it would be crucial to understand whether sensory processing atypicality exist also in AN. Further, it would be essential to find if atypical sensory processing is associated with eating disturbances in individuals with AN, since treatment modifications may be needed. We therefore aimed to examine whether atypical sensory processing is associated with AN and its core characteristics. MethodsParticipants of the current study included 42 individuals with AN and 40 healthy controls (HCs). All participants were adult women. Sensory processing, other ASD traits, and eating disorder symptoms were assessed with self-report questionnaires. ResultsIndividuals with AN reported lower registration, decreased sensation seeking, increased sensory sensitivity, and increased sensation avoiding compared to HCs. When analyzing groups with restrictive AN (AN-R) and binge-purge type AN (AN-BP) separately, only individuals with AN-R exhibited decreased sensation seeking, and only those with AN-BP exhibited lower registration. After controlling for body mass index as a covariate, group differences remained significant only in sensory sensitivity between individuals with AN and HCs. Increased atypical sensory processing predicted lower body mass index and increased disordered eating. ConclusionResults suggest that sensory processing appears to differ between AN and HC women, and AN subtypes may exhibit distinct sensory processing atypicality. Sensory sensitivity may be stable traits whereas other aspects of atypical sensory processing may be related to acute AN. Atypical sensory processing may contribute to the severity of AN, and thus it is crucial to recognize sensory processing differences when treating individuals with AN.Peer reviewe

Emotion recognition, alexithymia, empathy, and emotion regulation in women with anorexia nervosa

Purpose Anorexia nervosa (AN) is associated with challenges in recognizing, understanding, and interpreting one's own and other's emotional states, feelings, and thoughts. It is unknown whether difficulties in emotion processing occur independently of common comorbid symptoms of AN and predict acute eating disorder characteristics. We aimed to examine emotion recognition, alexithymia, emotion regulation, and empathy in individuals with AN and to assess whether these predict eating disorder symptoms independently from comorbid symptoms. Methods Participants included 42 women with AN and 40 healthy control (HC) women between 18-30 years. Basic and complex emotion recognition was assessed with face photos and video clips. Alexithymia, empathy, emotion regulation, and comorbid symptoms (anxiety, depressive, and obsessive-compulsive symptoms and ASD traits) were assessed with self-assessment questionnaires. Results Participants with AN exhibited difficulties in basic and complex emotion recognition, as well as increased alexithymia, decreased empathy, and challenges in emotion regulation when compared to HCs. After controlling for comorbid symptoms, differences remained only in complex emotion recognition. Challenges in emotion recognition were associated with lower body mass index, and increased alexithymia was associated with increased eating disorder symptoms. Increased challenges in emotion regulation were associated with a shorter duration of illness, higher body mass index, and increased eating disorder symptoms. Conclusions Participants with AN displayed widespread deficit in emotion processing, but only challenges in complex emotion recognition occurred independently from comorbid symptoms. Deficits in emotion processing may contribute to the illness severity and thus could be an important treatment target.Peer reviewe

Evaluating bicyclists’ risk perception using video clips: Comparison of frequent and infrequent city cyclists

Abstract Hazard and risk perception has been studied extensively among car drivers, and their link to crash involvement is established. Bicyclists, in particular, are vulnerable road users. Better understanding of their risk and hazard perception could help to improve their traffic safety. In this study, we investigated the risk perception of bicyclists in a city environment. Two groups of bicyclists were compared: 19 frequent and 19 infrequent bicyclists. Participants were shown video clips taken with a camera attached to the handlebar of a bicycle, and they were asked to continuously indicate with a slider how much caution the situation needed. The frequent cyclists had more frequent rises in the caution estimate, which suggest that they anticipated or detected more hazards than infrequent cyclists. This is in line with the classical hazard perception results, which link the car driving experience to faster and more accurate hazard perception. The overall level or caution was not directly related to the rise event rate or bicycling frequency. Those cyclists who reported typically cycling faster than others showed elevated overall level of caution on sidewalks compared with others, but there was no difference on bike paths.Hazard and risk perception has been studied extensively among car drivers, and their link to crash involvement is established. Bicyclists, in particular, are vulnerable road users. Better understanding of their risk and hazard perception could help to improve their traffic safety. In this study, we investigated the risk perception of bicyclists in a city environment. Two groups of bicyclists were compared: 19 frequent and 19 infrequent bicyclists. Participants were shown video clips taken with a camera attached to the handlebar of a bicycle, and they were asked to continuously indicate with a slider how much caution the situation needed. The frequent cyclists had more frequent rises in the caution estimate, which suggest that they anticipated or detected more hazards than infrequent cyclists. This is in line with the classical hazard perception results, which link the car driving experience to faster and more accurate hazard perception. The overall level or caution was not directly related to the rise event rate or bicycling frequency. Those cyclists who reported typically cycling faster than others showed elevated overall level of caution on sidewalks compared with others, but there was no difference on bike paths. (C) 2015 Elsevier Ltd. All rights reserved.Peer reviewe

Laihuushäiriö ja autismikirjo

Laihuushäiriöön liittyy usein autismikirjolle tyypillisiä piirteitä, eli vaikeuksia sosiaalisessa tiedonkäsittelyssä ja vuorovaikutuksessa, joustamatonta ja kaavamaista käyttäytymistä sekä aistitiedon käsittelyn poikkeavuuksia. Osa laihuushäiriötä sairastavista täyttää autismikirjon häiriön diagnostiset kriteerit, ja heillä syömishäiriöoireiden taustalla vaikuttavat autismikirjon piirteet. Lisäksi joillain autismikirjon piirteet mahdollisesti korostuvat akuutin laihuushäiriön aikana. Autismikirjon piirteet liittyvät laihuushäiriön heikompaan ennusteeseen ja lisäävät häiriön pitkittymisen riskiä. Laihuushäiriötä sairastavat autismikirjolla olevat henkilöt eivät mahdollisesti hyödy riittävästi laihuushäiriön tämänhetkisistä hoitomenetelmistä, ja hoitokäytäntöjä tulisikin muokata niin, että heitä hoidettaessa autismikirjon piirteet huomioitaisiin nykyistä paremmin.Peer reviewe

Predictive coding of phonological rules in auditory cortex : A mismatch negativity study

The brain is constantly generating predictions of future sensory input to enable efficient adaptation. In the auditory domain, this applies also to the processing of speech. Here we aimed to determine whether the brain predicts the following segments of speech input on the basis of language-specific phonological rules that concern non-adjacent phonemes. Auditory event-related potentials (ERP) were recorded in a mismatch negativity (MMN) paradigm, where the Finnish vowel harmony, determined by the first syllables of pseudowords, either constrained or did not constrain the phonological composition of pseudoword endings. The phonological rule of vowel harmony was expected to create predictions about phonologically legal pseudoword endings. Results showed that MMN responses were larger for phonologically illegal than legal pseudowords, and P3a was elicited only for illegal pseudowords. This supports the hypothesis that speech input is evaluated against context-dependent phonological predictions that facilitate speech processing. (C) 2016 Elsevier Inc. All rights reserved.Peer reviewe

Enhanced Memory Consolidation Via Automatic Sound Stimulation During Non-REM Sleep

Introduction: Slow-wave sleep (SWS) slow waves and sleep spindle activity have been shown to be crucial for memory consolidation. Recently, memory consolidation has been causally facilitated in human participants via auditory stimuli phase-locked to SWS slow waves. Aims: Here, we aimed to develop a new acoustic stimulus protocol to facilitate learning and to validate it using different memory tasks. Most importantly, the stimulation setup was automated to be applicable for ambulatory home use. Methods: Fifteen healthy participants slept 3 nights in the laboratory. Learning was tested with 4 memory tasks (word pairs, serial finger tapping, picture recognition, and face-name association). Additional questionnaires addressed subjective sleep quality and overnight changes in mood. During the stimulus night, auditory stimuli were adjusted and targeted by an unsupervised algorithm to be phase-locked to the negative peak of slow waves in SWS. During the control night no sounds were presented. Results: Results showed that the sound stimulation increased both slow wave (p =.002) and sleep spindle activity (p Conclusions: We showed that the memory effect of the SWS-targeted individually triggered single-sound stimulation is specific to verbal associative memory. Moreover, the ambulatory and automated sound stimulus setup was promising and allows for a broad range of potential follow-up studies in the future.Peer reviewe

Brain structural alterations in autism and criminal psychopathy

Publisher Copyright: © 2022 The AuthorsThe goal of this study was to elucidate the anatomical brain basis of social cognition through two disorders with distinctively different phenotypes of social interaction. We compared structural MR images of 20 individuals with autism spectrum disorder (ASD), 19 violent offenders with high psychopathic traits, and 19 control participants using voxel-based morphometry (VBM). Our earlier study showed lower grey matter volume (GMV) values in the insula, frontal cortex, and sensorimotor cortex of the offender group compared to controls. In the present study, the images of the ASD group revealed lower GMV in the left precuneus, right cerebellum, and right precentral gyrus in comparison with controls. The comparison between the offender and ASD groups showed lower GMV values for the right temporal pole and left inferior frontal gyrus in the offender group. There was also an overlap of both disorders in the right pre-central cortex, showing lower GMV compared to controls. Our findings suggest structural differences between violent offenders with high psychopathy traits and ASD individuals in the frontotemporal social brain network areas, previously associated with empathy. We also provide evidence of similar abnormal structures in the motor cortex for both of these disorders, possibly related to uniting issues of social cognition.Peer reviewe

Brain structural alterations in autism and criminal psychopathy

The goal of this study was to elucidate the anatomical brain basis of social cognition through two disorders with distinctively different phenotypes of social interaction. We compared structural MR images of 20 individuals with autism spectrum disorder (ASD), 19 violent offenders with high psychopathic traits, and 19 control participants using voxel-based morphometry (VBM). Our earlier study showed lower grey matter volume (GMV) values in the insula, frontal cortex, and sensorimotor cortex of the offender group compared to controls. In the present study, the images of the ASD group revealed lower GMV in the left precuneus, right cerebellum, and right precentral gyrus in comparison with controls. The comparison between the offender and ASD groups showed lower GMV values for the right temporal pole and left inferior frontal gyrus in the offender group. There was also an overlap of both disorders in the right pre-central cortex, showing lower GMV compared to controls. Our findings suggest structural differences between violent offenders with high psychopathy traits and ASD individuals in the frontotemporal social brain network areas, previously associated with empathy. We also provide evidence of similar abnormal structures in the motor cortex for both of these disorders, possibly related to uniting issues of social cognition

Cognitive Behavioral and Cognitive Remediation Strategies for Managing Co-Occurring Anorexia Nervosa and Elevated Autism Spectrum Traits

Anorexia nervosa (AN) is a potentially severe eating disorder whose core characteristics include energy intake restriction leading to low body weight. Autism spectrum disorder (ASD) is a developmental disorder characterized by deficits in social interaction and communication as well as repetitive, stereotyped behavior and interests. Both high ASD traits and diagnosed ASD are over-represented among individuals with AN, and AN and ASD appear to share certain neurocognitive features. These features are associated with the severity of eating disorder symptoms and prolongation of AN. Thus, individuals with AN and high ASD traits or ASD may benefit less from traditional treatment when compared to those with low ASD traits. No previous reviews have summarized what is known about treatment adaptations for individuals with AN and high ASD traits or ASD. The purpose of this narrative review was to investigate the feasibility of cognitive remediation therapy (CRT), cognitive remediation and emotional skill training (CREST), and cognitive behavioral therapy (CBT), and give an overview of treatment modifications for individuals with AN and co-occurring ASD or high ASD traits. We found nine studies that fulfilled our inclusion criteria. The combined results suggest that individuals with AN and high ASD traits or ASD benefit less from CRT, CREST, and CBT than those with AN and low ASD traits. However, CRT and CREST administered in individual format may be associated with improved cognitive flexibility, motivation for change, and decreased alexithymia among adults with AN and high ASD traits or ASD. Individuals with comorbid AN and ASD themselves highlight the importance of treatment adaptations that take the characteristics of ASD into account. In the future, controlled studies of the treatment strategies for individuals with AN and ASD/high ASD traits are needed in order to improve the outcome of individuals with this challenging comorbidity.Peer reviewe