Aging with Elevated Autistic Traits: Cognitive Functioning Among Older Adults with the Broad Autism Phenotype

Background: Little is known about the impact of aging with autism spectrum disorder (ASD) on cognition. As a first step in addressing this gap in our knowledge, the current study examined cognitive functioning among older adults with elevated, but subclinical levels of autistic traits (i.e., the Broad Autism Phenotype; BAP) compared to older adults without the BAP. Method: Forty older adults (aged 60-91, M=73 years) were recruited and classified as meeting criteria for the BAP (n=20) or not (control older adults, COA; n=20). Different components of executive function as well as episodic memory were measured using standardized performance-based neuropsychological assessments in addition to a self-report questionnaire of executive function difficulties. Results: Despite no differences in age, sex ratio, educational history or IQ, the BAP group demonstrated poorer performance on measures of executive function and episodic memory compared to the COA group. The BAP group also self-reported more executive function difficulties in everyday settings. Moreover, differences in working memory and attentional shifting were maintained after accounting for the influences of IQ and both depression and anxiety symptoms. Conclusions: These findings suggest that aging with the BAP confers additional risk to cognitive function for older adults. As the BAP forms a bridge in the continuum from typical to atypical levels of autistic traits, these findings suggest that individuals with ASD might also incur cognitive costs as they age into older adulthood

Social Support and Links to Quality of Life Among Middle and Older Age Autistic Adults

Social support has a positive impact on quality of life (QoL) in neurotypical older adults and young autistic adults, but the association for older autistic adults is unclear. Autistic adults (n=388; mean age=40-83 years) were recruited via Simons Powering Autism Research for Knowledge research match. Participants completed questionnaires online querying demographic information, depression and anxiety symptomatology, QoL (Physical, Psychological, Social, Environmental, Autism-specific) and social support (instrumental, subjective and social interactions). Regression analyses examined whether different aspects of social support explained the variance in each domain of QoL. A significant proportion of the variance (36-58%) in QoL was explained. Subjective social support significantly contributed to the models for all aspects of QoL; Physical and Psychological QoL were also explained by social interactions, whereas Social, Environmental and Autism-specific QoL were additionally explained by instrumental support. Social support is an important contributor to the QoL of middle-aged and older autistic adults, after accounting for demographic factors and depression. Further studies are required to understand whether age-related changes in social support and QoL are the same for autistic as non-autistic older adults in order to identify and implement appropriate support

Cardiovascular risk and emotion regulation contribute to depression symptomatology in middle-aged and older autistic adults

Background: Cardiovascular risk factors (CVRF) and executive function difficulties increase during later-life and are associated with depression symptoms among non-autistic older people. These associations, however, have not yet been explored among middle-aged and older autistic people. Methods: Using data collected via Simons Foundation Powering Autism Research (SPARK), Research Match, we examined the frequency of CVRF, and associations between CVRF, executive function and depression symptoms in 387 middle-aged and older autistic people (aged 40-83 years). Results: Autistic adults reported high rates of CVRF (two, 28.9%; three or more, 23.2%). Rates of high cholesterol and obesity were greater among middle-aged and older autistic adults compared to the general population. CVRF, age, and emotion regulation (but not inhibitory control), were significantly associated with depression symptoms in middle-aged and older autistic adults. Conclusions: CVRF occur at high rates in middle-aged and older autistic adults, and it is important that healthcare providers monitor risk factors in order to implement preventative strategies. CVRF are associated with depressive symptoms among middle-aged and older autistic adults, but may not be as important as difficulties with emotion regulation

Self-reported prospective and retrospective memory among middle aged and older autistic and non-autistic people

Objective: Self-reported memory difficulties are common among older adults, but few studies have examined memory problems among autistic middle-aged and older people. The current study examines self-rated prospective (PM) and retrospective (RM) memory difficulties and their associations with age in middle-aged and older autistic and non-autistic people. Methods: 350 autistic people (58% assigned-female-at-birth; age-range: 40-83 years) and 350 non-autistic adults matched on age, birth-sex and education level were included in the analysis. Participants completed the Prospective and Retrospective Memory Questionnaire (PRMQ) which includes questions about PM vs. RM (memory type), environment-cued vs. self-cued (cue), and short vs. long delay (delay). Results: Autistic people reported significantly more PM and RM difficulties than the comparison group. Both groups reported more difficulties with PM (vs. RM), self-cued (vs. environment-cued), and short (vs. long) delay. No significant interactions were observed. Among autistic people, younger age was associated with reporting more PM and RM difficulties, but this pattern was not observed among non-autistic people. Conclusions: Autistic people may be at reduced risk for memory problems as they age, compared to their same-age non-autistic peers. Further studies are required to explore the association between self-reported memory challenges and memory task performance among autistic older people

Insistence on sameness relates to increased covariance of gray matter structure in autism spectrum disorder.

BACKGROUND: Autism spectrum disorder (ASD) is characterized by atypical development of cortical and subcortical gray matter volume. Subcortical structural changes have been associated with restricted and repetitive behavior (RRB), a core component of ASD. Behavioral studies have identified insistence on sameness (IS) as a separable RRB dimension prominent in high-functioning ASD, though no simple brain-behavior relationship has emerged. Structural covariance, a measure of morphological coupling among brain regions using magnetic resonance imaging (MRI), has proven an informative measure of anatomical relationships in typical development and neurodevelopmental disorders. In this study, we use this measure to characterize the relationship between brain structure and IS. METHODS: We quantified the structural covariance of cortical and subcortical gray matter volume in 55 individuals with high-functioning ASD using 3T MRI. We then related these structural metrics to individual IS scores, as assessed by the Repetitive Behavior Scale-Revised (RBS-R). RESULTS: We found that increased coupling among subcortical regions and between subcortical and cortical regions related to greater IS symptom severity. Most pronounced, the striatum and amygdala participated in a plurality of identified relationships, indicating a central role for these structures in IS symptomatology. These structural associations were specific to IS and did not relate to any of the other RRB subcomponents measured by the RBS-R. CONCLUSIONS: This study indicates that behavioral dimensions in ASD can relate to the coordination of development across multiple brain regions, which might be otherwise obscured using typical brain-behavior correlations. It also expands the structures traditionally related to RRB in ASD and provides neuroanatomical evidence supportive of IS as a separate RRB dimension. TRIAL REGISTRATION: ClinicalTrials.gov NCT01031407

Interfering with Inner Speech Selectively Disrupts Problem-Solving and is Linked with Real-World Executive Functioning

Purpose: According to Vygotskian theory, verbal thinking serves to guide our behavior and underpins critical self-regulatory functions. Indeed, numerous studies now link inner speech usage with performance on tests of executive function. However, the selectivity of inner speech contributions to multi-factorial executive planning performance and links with real-world functioning are limited. Therefore, the present study seeks to fill this gap in our knowledge. Method: Fifty-one adults completed the Tower of London under two conditions: (1) articulatory suppression and (2) foot tapping as well as self-ratings of real-world executive functioning (utilizing the Behavior Rating Inventory of Executive Function-Adult version). Results: Interfering with inner speech selectively disrupted Tower of London performance over and above a simultaneous motor task (i.e., foot tapping). Furthermore, this selectivity in performance was linked with real-world self-monitoring. Conclusion: These results provide further evidence for specific links between verbal thinking and executive function (particularly using multifactorial tasks of planning) and suggest that inner speech might serve as a key intervention target in clinical disorders where executive function deficits are prominent

Interfering with Inner Speech Selectively Disrupts Problem-Solving and is Linked with Real-World Executive Functioning

Purpose: According to Vygotskian theory, verbal thinking serves to guide our behavior and underpins critical self-regulatory functions. Indeed, numerous studies now link inner speech usage with performance on tests of executive function. However, the selectivity of inner speech contributions to multi-factorial executive planning performance and links with real-world functioning are limited. Therefore, the present study seeks to fill this gap in our knowledge. Method: Fifty-one adults completed the Tower of London under two conditions: (1) articulatory suppression and (2) foot tapping as well as self-ratings of real-world executive functioning (utilizing the Behavior Rating Inventory of Executive Function-Adult version). Results: Interfering with inner speech selectively disrupted Tower of London performance over and above a simultaneous motor task (i.e., foot tapping). Furthermore, this selectivity in performance was linked with real-world self-monitoring. Conclusion: These results provide further evidence for specific links between verbal thinking and executive function (particularly using multifactorial tasks of planning) and suggest that inner speech might serve as a key intervention target in clinical disorders where executive function deficits are prominent

Cardiovascular disease risk factors in autistic adults: The impact of sleep quality and antipsychotic medication use

Approximately 40% of American adults are affected by cardiovascular disease (CVD) risk factors (e.g., high blood pressure, high cholesterol, diabetes, and overweight or obesity), and risk among autistic adults may be even higher. Mechanisms underlying the high prevalence of CVD risk factors in autistic people may include known correlates of CVD risk factors in other groups, including high levels of perceived stress, poor sleep quality, and antipsychotic medication use. A sample of 545 autistic adults without intellectual disability aged 18+ were recruited through the Simons Foundation Powering Autism Research, Research Match. multiple linear regression models examined the association between key independent variables (self-reported perceived stress, sleep quality, and antipsychotic medication use) and CVD risk factors, controlling for demographic variables (age, sex assigned at birth, race, low-income status, autistic traits). Overall, 73.2% of autistic adults in our sample had an overweight/obesity classification, 45.3% had high cholesterol, 39.4% had high blood pressure, and 10.3% had diabetes. Older age, male sex assigned at birth, and poorer sleep quality were associated with a higher number of CVD risk factors. Using antipsychotic medications was associated with an increased likelihood of having diabetes. Poorer sleep quality was associated with an increased likelihood of having an overweight/obesity classification. Self-reported CVD risk factors are highly prevalent among autistic adults. Both improving sleep quality and closely monitoring CVD risk factors among autistic adults who use antipsychotic medications have the potential to reduce risk for CVD

Interests in high-functioning autism are more intense, interfering, and idiosyncratic than those in neurotypical development

Although circumscribed interests are pathognomonic with autism, much about these interests remains unknown. Using the Interests Scale (IS), this study compares interests between 76 neurotypical (NT) individuals and 109 individuals with high-functioning autism spectrum disorder (HF-ASD) matched groupwise on age, IQ, and gender ratio. Participants and their parents/caregivers completed diagnostic measures (the Autism Diagnostic Interview—Revised and the Autism Diagnostic Observation Schedule; HF-ASD only), cognitive tests (Wechsler IQ Scales), and questionnaires (the Repetitive Behavior Scale—Revised, the Behavior Rating Inventory of Executive Function, and the Social Responsiveness Scale), in addition to the IS. Consistent with previous research, HF-ASD and NT individuals did not differ in number of interest areas, but the types of interests and intensity of those interests differed considerably. Using only the IS intensity score, 81% of individuals were correctly classified (NT or HF-ASD) in a logistic regression analysis. Among individuals with HF-ASD, Interests Scale scores were significantly related to Autism Diagnostic Observation Schedule, Behavior Rating Inventory of Executive Function, Repetitive Behavior Scale—Revised, and Social Responsiveness Scale scores, but they were not related to Autism Diagnostic Interview—Revised scores, IQ, gender, age, or psychotropic medication use. The type and intensity, but not the number, of interests distinguish high-functioning individuals with ASD from NT individuals