非侵入性脑刺激技术在自闭症谱系障碍中的运用

作者：

Lindsay M. Oberman  Sunday M. Francis  Sarah H. Lisanby

摘要：

Noninvasive brain stimulation (NIBS) techniques, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), have recently emerged as alternative, nonpharmacological interventions for a variety of psychiatric, neurological, and neurodevelopmental conditions. NIBS is beginning to be applied in both research and clinical settings for the treatment of core and associated symptoms of autism spectrum disorder (ASD) including social communication deficits, restricted and repetitive behaviors, irritability, hyperactivity, depression and impairments in executive functioning and sensorimotor integration. Though there is much promise for these targeted device-based interventions, in other disorders (including adult major depressive disorder (MDD) and obsessive compulsive disorder (OCD) where rTMS is FDA cleared), data on the safety and efficacy of these interventions in individuals with ASD is limited especially in younger children when neurodevelopmental interventions typically begin. Most studies are open-label, small scale, and/or focused on a restricted subgroup of individuals with ASD. There is a need for larger, randomized controlled trials that incorporate neuroimaging in order to develop predictive biomarkers of treatment response and optimize treatment parameters. We contend that until such studies are conducted, we do not have adequate estimates of the safety and efficacy of NIBS interventions in children across the spectrum. Thus, broad off-label use of these techniques in this population is not supported by currently available evidence. Here we discuss the existing data on the use of NIBS to treat symptoms related to ASD and discuss future directions for the field.

非侵入性脑刺激( NIBS )技术，包括重复经颅磁刺激( r TMS )和经颅直流电刺激( t DCS )，最近已成为多种精神、神经和神经发育状况的替代非药物干预措施。NIBS已开始应用于自闭症谱系障碍( ASD )核心及相关症状的研究和临床治疗，包括社会交往障碍、限制性和重复性行为、易激惹、多动、抑郁、执行功能和感觉运动整合障碍等。尽管这些基于设备的有针对性的干预措施很有希望，但在其他疾病中(包括成人重性抑郁障碍( MDD ))。大多数研究都是开放性的，小规模的，和/或集中在ASD患者的一个受限亚组。为了开发治疗反应的预测生物标志物和优化治疗参数，需要纳入神经成像的更大的随机对照试验。我们认为，在进行这些研究之前，我们没有足够的估计在整个范围内儿童NIBS干预的安全性和有效性。因此，这些技术在该人群中的广泛超说明书使用没有得到现有证据的支持。在此，我们讨论使用NIBS治疗ASD相关症状的现有数据，并讨论该领域的未来方向

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自闭症和非自闭症成年人在观看真实人物和非真实人物时的社会注意模式

作者：

Beatriz López, Nicola Jean Gregory and Megan Freeth

摘要：

Research consistently shows that autistic adults do not attend to faces as much as non-autistic adults. However, this conclusion is largely based on studies using pre-recorded videos or photographs as stimuli. In studies using real social scenarios, the evidence is not as clear. To explore the extent to which differences in findings relate to differences in the methodologies used across studies, we directly compared social attention of 32 autistic and 33 non-autistic adults when watching exactly the same video. However, half of the participants in each group were told simply to watch the video (Video condition), and the other half were led to believe they were watching a live webcam feed (‘Live’ condition). The results yielded no significant group differences in the ‘Live’ condition. However, significant group differences were found in the ‘Video’ condition. In this condition, non-autistic participants, but not autistic participants, showed a marked social bias towards faces. The findings highlight the importance of studying social attention combining different methods. Specifically, we argue that studies using pre-recorded footage and studies using real people tap into separate components contributing to social attention. One that is an innate, automatic component and one that is modulated by social norms

研究一致表明，自闭症成年人对面孔的注意不如非自闭症成年人多。然而，这一结论在很大程度上是基于使用预先录制的视频或照片作为刺激的研究。在使用真实社会情景的研究中，证据并不那么清晰。为了探讨研究结果的差异在多大程度上与研究方法的差异有关，我们直接比较了32名自闭症和33名非自闭症成年人在观看完全相同的视频时的社会注意力。然而，每组中的一半参与者被告知只是简单地观看视频(视频条件)，另一半被引导相信他们正在观看网络摄像头直播( ( “活着”的状态) )。结果在” Live “条件下没有显著的组间差异。

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重新审视学习年龄与自闭症和成人结果之间的关联

作者：

Florence YN Leung, Punit Shah , David Mason and Lucy A Livingston

摘要：

It was recently reported that learning one is autistic earlier in life is associated with greater quality of life and well-being in university students. In a pre-registered extension of this work, we addressed several limitations of this study by (a) recruiting a larger sample of more diverse ages and education levels, (b) distinguishing between learning about and receiving an autism diagnosis, (c) accounting for additional confounding variables, and (d) studying different quality of life dimensions. Autistic adults (N = 300) reported when they first learned they were autistic, as well as when they actually received an autism diagnosis, and provided detailed socio-demographic information. Participants also completed measures of their autistic traits, as well as well-being and quality of life across multiple domains. In contrast to recent research, we found the age participants first learned they were autistic did not significantly and uniquely predict their quality of life and well-being. Rather, having more autistic traits was the strongest predictor of poorer quality of life and well-being, while other socio-demographic factors were also relevant. We discuss the implications of these findings for understanding and improving outcomes in autistic adults and call for higher quality open science on this important topic.

最近有研究报道，学习一个人在生活中更早出现自闭症与大学生更高的生活质量和幸福感有关。在这项工作的预注册扩展中，我们通过( a )招募年龄和教育水平更多样化的更大样本，( b )区分学习自闭症和接受自闭症诊断，( c )考虑额外的混杂变量，以及( d )研究不同的生活质量维度来解决本研究的一些局限性。自闭症成年人( N = 300)报告了当他们第一次得知他们是自闭症患者时，以及他们实际接受自闭症诊断时，并提供了详细的社会人口学信息。参与者还完成了他们的自闭特质，以及幸福感和质量的测量。

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探讨孤独症中重复和限制性行为和兴趣的多维本质：神经解剖学关联和临床意义

作者：

Aline Lefebvre, Nicolas Traut, Amandine Pedoux, Anna Maruani, Anita Beggiato, Monique Elmaleh, David Germanaud, Anouck Amestoy, Myriam Ly‑Le Moal, Christopher Chatham, Lorraine Murtagh, Manuel Bouvard, Marianne Alisson, Marion Leboyer, Thomas Bourgeron, Roberto Toro, Guillaume Dumas, Clara Moreau and Richard Delorme

摘要：

Background： Repetitive and restricted behaviors and interests (RRBI) are core symptoms of autism with a complex entity and are commonly categorized into ‘motor‑driven’ and ‘cognitively driven’. RRBI symptomatology depends on the individual’s clinical environment limiting the understanding of RRBI physiology, particularly their associated neuroanatomical structures. The complex RRBI heterogeneity needs to explore the whole RRBI spectrum by integrating the clinical context [autistic individuals, their relatives and typical developing (TD) individuals]. We hypothesized that different RRBI dimensions would emerge by exploring the whole spectrum of RRBI and that these dimensions are associated with neuroanatomical signatures—involving cortical and subcortical areas.

Method： A sample of 792 individuals composed of 267 autistic subjects, their 370 first‑degree relatives and 155 TD individuals was enrolled in the study. We assessed the whole patterns of RRBI in each individual by using the Repetitive Behavior Scale‑Revised and the Yale‑Brown Obsessive Compulsive Scale. We estimated brain volumes using MRI scanner for a subsample of the subjects (n = 152, 42 ASD, 89 relatives and 13 TD). We first investigated the dimensionality of RRBI by performing a principal component analysis on all items of these scales and included all the sampling population. We then explored the relationship between RRBI‑derived factors with brain volumes using linear regression models.

Results ：We identified 3 main factors (with 30.3% of the RRBI cumulative variance): Factor 1 (FA1, 12.7%) reflected mainly the ‘motor‑driven’ RRBI symptoms; Factor 2 and 3 (respectively, 8.8% and 7.9%) gathered mainly Y‑BOCS related items and represented the ‘cognitively driven’ RRBI symptoms. These three factors were significantly associated with the right/left putamen volumes but with opposite effects: FA1 was negatively associated with an increased volume of the right/left putamen conversely to FA2 and FA3 (all uncorrected p < 0.05). FA1 was negatively associated with the left amygdala (uncorrected p < 0.05), and FA2 was positively associated with the left parietal structure (uncorrected p = 0.001).

背景：重复受限的行为和兴趣( RRBI )是自闭症的核心症状，是一个复杂的整体，通常分为”运动驱动”和”认知驱动”。RRBI的症状学取决于个体的临床环境，限制了对RRBI生理学，特别是其相关的神经解剖结构的理解。复杂的RRBI异质性需要通过整合临床背景[自闭症个体及其亲属和典型发育( TD )个体来探索整个RRBI谱系。我们假设，通过探索RRBI的整个频谱，会出现不同的RRBI维度，并且这些维度与神经解剖学特征相关- -涉及皮层和皮层下区域。

方法：本研究共招募了792名被试，包括267名自闭症被试及其370名一级亲属和155名TD被试。我们使用重复行为量表( Repetitive Behavior Scale‐Revised )和耶鲁-布朗强迫量表( Yale‐Brown Obsessive Compulsive Scale )评估每个个体的RRBI整体模式。我们使用MRI扫描仪对受试者( n = 152 , ASD42例,亲属89例, TD13例)的子样本进行了脑体积估计。我们首先通过对这些量表的所有项目进行主成分分析来调查RRBI的维度，并将所有抽样人群包括在内。然后，我们使用线性回归模型探讨了RRBI衍生因子与大脑体积之间的关系。

结论：我们确定了3个主要因子(具有30.3 %的RRBI累积方差)：因子1 ( FA1为12.7 %)主要反映”运动驱动型” RRBI症状；因子2和3 ( 8 %和7 . 9 %)主要聚集了Y‐BOCS相关条目，代表了”认知驱动”的RRBI症状。这3个因子与右壳核/左壳核体积显著相关，但作用相反：FA1与右壳核/左壳核体积增加呈负相关，FA2和FA3与(所有未校正p < 0.05)呈负相关。FA1与左侧杏仁核(未校正p < 0.05)呈负相关，FA2与左侧顶叶结构(未校正p = 0.001)呈正相关。

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简短报告：评估照顾者实施的干预对提高自闭症幼儿社会交往能力的作用

作者；

Audrey A. Rouhandeh · Christine Honsberger · Nathaniel A. Shanok· Erin Brooker Lozott · Tess Levy · Alexander Kolevzon1 · Joseph D. Buxbaum1 · Marlene Sotelo · Jennifer Foss‑Feig· Paige M. Siper

摘要：

As early identification of autism improves, there is a critical need for interventions to support the development of social communication skills in toddlers. Caregiver coaching and parental involvement is crucial for improving outcomes and providing children with adequate hours of planned active engagement. This pilot study assessed a 4-week intervention for individual caregiver–child dyads. Eight toddlers 21- to 45-months of age participated. Standardized assessments were collected at four study visits to assess autism symptomatology, language development, and both caregiver knowledge and engagement. Results demonstrated the feasibility of the intervention. Social communication, receptive and expressive language all improved as measured by direct assessment. Caregiver knowledge and caregivers’ subjective feelings of engagement with their toddlers also improved.

随着自闭症早期识别的提高，迫切需要干预措施来支持幼儿社会交往能力的发展。照顾者的指导和家长的参与对于改善结果和为儿童提供足够时间的有计划的积极参与至关重要。本试点研究对个别照料者与二元关系进行了为期4周的干预评估。8名21 ~ 45个月的幼儿参加了实验。在4次研究访问中收集标准化评估，以评估自闭症症状学、语言发育以及照顾者的知识和参与。结果证明了干预的可行性。通过直接评估，社会交往、接受性和表达性语言都有所改善照料者知识和照料者技能。

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中国自闭症谱系障碍患儿家庭的直接和间接成本

作者：Zhao, YA (Zhao, Yanan) ; Luo, YA (Luo, Yanan)  ; Zhang, R (Zhang, Rong) ; Zheng, XY (Zheng, Xiaoying)

摘要：Autism spectrum disorder has gained international attention due to its prevalence and the extent to which it can affect families. As a disorder without quantifiable treatment effects, it is easily overlooked in the battle for resources. Estimating family economic burdens and the specific factors that may be associated with them could help in the identification of resources and the promotion of social justice. We examined the family costs from a national family survey with Children with autism spectrum disorder aged 2-6 years (N = 3236). A three-tiered model to quantify the costs was used. The families’ average annual direct cost per child was $24,869.0, including direct medical cost (inpatient, outpatient,drugs, etc.) of $6009.2 and direct nonmedical cost (rehabilitation or educational, rental, transportation, care, and others) of $18,859.8. The annual indirect costs (productivity loss from resignation and job adjustment) for families were $13,990.7. The total costs were $34,206.5. The results of the regression revealed that the mothers’ educational level was significantly associated with costs. Families with an interprovincial immigration background, a higher-than-average income, or children with more severe autism spectrum disorder had a greater possibility of higher direct, indirect, and overall costs. Autism spectrum disorder imposed a significant financial burden on the families of children with autism spectrum disorder. Lay abstract This is the first comprehensive national study to explore the direct and indirect costs for families of children with autism spectrum disorder in China. The increasing prevalence of autism spectrum disorder highlights a growing need for resources to provide care for families of children with autism spectrum disorder. The medical and nonmedical costs and parents’ productivity loss have caused a serious burden on their families. Our objective is to estimate the direct and indirect costs for the families of children with autism spectrum disorder in China. The target population was parents of children with autism spectrum disorder. We analyzed the costs using cross-sectional data from a Chinese national family survey with children aged 2-6 years (N = 3236) who were clinically diagnosed with autism spectrum disorder. Family data from 30 provinces in China were obtained. Cost items included direct medical costs, direct nonmedical costs, and indirect costs. In this study, we found that the largest part of family costs for autism spectrum disorder are nonmedical costs and productivity loss. Autism spectrum disorder has imposed a huge economic burden on parents having children with autism spectrum disorder in China, who need more support than the current health care system provides.

自闭症谱系障碍因其患病率及其对家庭的影响程度而引起国际关注。作为一种没有可量化治疗效果的疾病，在资源争夺战中很容易被忽视。估计家庭经济负担和可能与之相关的具体因素有助于确定资源和促进社会正义。我们检查了对 2-6 岁自闭症谱系障碍儿童 （N = 3236） 的全国家庭调查的家庭成本。使用三层模型来量化成本。这些家庭每个孩子的平均年度直接费用为 24,869.0 美元，包括直接医疗费用（住院、门诊、药物等）为 6009.2 美元，直接非医疗费用（康复或教育、租金、交通、护理等）为 18,859.8 美元。家庭每年的间接成本（辞职和工作调整造成的生产力损失）为13,990.7美元。总费用为34 206.5美元。回归结果显示，母亲的教育水平与成本显著相关。具有跨省移民背景、收入高于平均水平或患有更严重自闭症谱系障碍的儿童的家庭更有可能获得更高的直接、间接和总体成本。自闭症谱系障碍给自闭症谱系障碍儿童的家庭带来了沉重的经济负担。摘要 这是中国首个探讨自闭症谱系障碍儿童家庭直接和间接成本的综合性全国性研究。自闭症谱系障碍患病率的增加凸显了对资源的需求越来越大，以便为自闭症谱系障碍儿童的家庭提供护理。医疗和非医疗费用以及父母的生产力损失给他们的家庭造成了沉重的负担。我们的目标是估计中国自闭症谱系障碍儿童家庭的直接和间接成本。目标人群是自闭症谱系障碍儿童的父母。我们使用来自中国全国家庭调查的横断面数据分析了成本，这些儿童年龄在2-6岁之间，临床上被诊断为自闭症谱系障碍（N = 3236）。从中国30个省份获得家庭数据。成本项目包括直接医疗费用、直接非医疗费用和间接费用。在这项研究中，我们发现自闭症谱系障碍的家庭成本的最大部分是非医疗成本和生产力损失。自闭症谱系障碍给中国自闭症谱系障碍儿童的父母带来了巨大的经济负担，他们需要比目前的医疗保健系统提供的更多的支持。

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智力障碍和情绪调节在孤独症-抑郁的关系

作者：Sáez-Suanes, GP (Saez-Suanes, Gema P.)  ; García-Villamisar, D (Garcia-Villamisar, Domingo)  ; Armentia, AD (Del Pozo Armentia, Araceli)

摘要：Research shows significant rates of depressive symptoms in people with autistic spectrum disorder and intellectual disabilities. Finding factors related to the development of depression in autism spectrum disorder and intellectual disability is necessary. Emotion regulation is associated with depression in autism spectrum disorder and intellectual disability. The role of the intellectual disability in this relationship is not clear, so it is necessary to clarify it. One hundred twenty-one adults (M = 35.46 years, SD = 9.46) with autism spectrum disorder and intellectual disabilities were evaluated to verify moderating role of intellectual disability and mediating role of emotion regulation. A moderated mediation analysis supported the moderated role of mild intellectual disability in the relationship mediated by emotional dysregulation between autism spectrum disorder and depression symptoms. These findings suggest that interventions designed to prevent or reduce depressive symptoms in people with autism spectrum disorder and mild intellectual disability should include among their goals emotional regulation. Lay abstract Many people with autism and intellectual disability have significant levels of depressive symptoms. However, this relationship is not clear. For this reason, knowing the factors that are associated with having depression in autism and intellectual disability is important. Emotion regulation is associated with depression in autism spectrum disorder and intellectual disability. After evaluating a group of people with autism and intellectual disability, we found that people with mild intellectual disability have problems regulating their emotions which lead them to develop depressive symptoms. These findings suggest that interventions designed to prevent or reduce depressive symptoms in people with autism spectrum disorder and mild intellectual disability should include among their goals emotional regulation.

研究表明，自闭症谱系障碍和智力障碍患者的抑郁症状发生率很高。有必要在自闭症谱系障碍和智力障碍中寻找与抑郁症发展相关的因素。情绪调节与自闭症谱系障碍和智力障碍中的抑郁症有关。智力障碍在这种关系中的作用尚不清楚，因此有必要加以澄清。对 121 例患有自闭症谱系障碍和智力障碍的成年人（M = 35.46 岁，SD = 9.46）进行评估，以验证智力障碍的调节作用和情绪调节的中介作用。一项有调节的中介分析支持轻度智力障碍在自闭症谱系障碍和抑郁症状之间情绪失调介导的关系中的调节作用。这些发现表明，旨在预防或减轻自闭症谱系障碍和轻度智力障碍患者的抑郁症状的干预措施应包括情绪调节。摘要：许多自闭症和智力障碍患者都有明显的抑郁症状。但是，这种关系尚不清楚。因此，了解与自闭症和智力障碍抑郁症相关的因素很重要。情绪调节与自闭症谱系障碍和智力障碍中的抑郁症有关。在评估了一组患有自闭症和智力障碍的人后，我们发现轻度智力障碍者在调节情绪方面存在问题，导致他们出现抑郁症状。这些发现表明，旨在预防或减轻自闭症谱系障碍和轻度智力障碍患者的抑郁症状的干预措施应包括情绪调节。

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马来西亚大学生自我报告的自闭症特征和社会心理结果

作者：Low, HM (Low, Hui Min) ; Zainal, MS (Zainal, Mohd Syazwan) ; Pang, JC (Pang, Jee Ching) ; Ang, Y (Ang, Yammy) ; de Vries, M (de Vries, Marieke)

摘要：An autism spectrum condition is considered a lifelong condition. Affected individuals typically experience poorer psychosocial outcomes compared to non-autistic individuals. However, in Southeast Asian countries such as Malaysia, research about autism spectrum conditions beyond the early childhood context is scarce, and therefore, the prevalence and psychosocial outcomes of young adults with autism spectrum conditions remain largely unknown. This study aims to explore self-reported autistic traits among university students in Malaysia, and their relation to emotion regulation, stress, self-efficacy and quality of life. Data from 2732 students revealed that 0.3% of the students reported having an autism spectrum condition diagnosis, while 2.5% reported that they suspected having an autism spectrum condition, but did not obtain a formal diagnosis. This indicates that an estimated 2.8% of students might have a diagnosed or suspected autism spectrum condition. These two categories of students were found to have poorer self-efficacy, higher perceived stress and poorer quality of life, as compared to their peers. However, these students were not significantly different from their peers in emotion regulation. Overall, the findings pointed to negative psychosocial outcomes associated with autism spectrum condition and culture-specific associations between autistic traits and psychosocial outcomes. Lay abstract Most research on autism spectrum conditions is done on young children and not as much on young adults with autism spectrum conditions. Because of this, not much is known about how common autism spectrum conditions are in young adults and how they affect their mental and social health, especially in Southeast Asia. Based on self-reports, 2.8% of the 2732 university students we looked at in Malaysia might have been diagnosed or thought to have an autism spectrum condition. Students who said they had or thought they had autism spectrum conditions had lower self-efficacy, more stress and a lower quality of life than students who said they did not have autism spectrum conditions. The results showed that university students with autism spectrum condition are more likely to have bad psychological and social outcomes than their peers without autism spectrum condition. Also, the link between autistic traits and psychosocial outcomes could depend on the culture.

自闭症谱系疾病被认为是一种终生疾病。与非自闭症患者相比，受影响的个体通常经历较差的社会心理结果。然而，在马来西亚等东南亚国家，关于儿童早期背景之外的自闭症谱系状况的研究很少，因此，患有自闭症谱系疾病的年轻人的患病率和社会心理结果在很大程度上仍然未知。本研究旨在探讨马来西亚大学生自我报告的自闭症特征，以及它们与情绪调节、压力、自我效能感和生活质量的关系。来自2732名学生的数据显示，0.3%的学生报告患有自闭症谱系疾病，而2.5%的学生报告他们怀疑患有自闭症谱系疾病，但没有获得正式诊断。这表明估计有 2.8% 的学生可能患有诊断或疑似自闭症谱系疾病。与同龄人相比，这两类学生的自我效能感较差，感知压力较高，生活质量较差。然而，这些学生在情绪调节方面与同龄人没有显着差异。总体而言，研究结果指出了与自闭症谱系状况相关的负面社会心理结果，以及自闭症特征与社会心理结果之间的文化特定关联。摘要 大多数关于自闭症谱系状况的研究都是在幼儿身上进行的，而不是对患有自闭症谱系状况的年轻人进行的。正因为如此，人们对年轻人的自闭症谱系疾病有多普遍以及它们如何影响他们的心理和社会健康知之甚少，尤其是在东南亚。根据自我报告，我们在马来西亚观察的 2732 名大学生中有 2.8% 可能被诊断或被认为患有自闭症谱系疾病。与说自己没有自闭症谱系疾病的学生相比，说自己患有或认为自己患有自闭症谱系疾病的学生自我效能感较低，压力更大，生活质量更低。结果显示，患有自闭症谱系疾病的大学生比没有自闭症谱系疾病的同龄人更容易出现不良的心理和社会结果。此外，自闭症特征与社会心理结果之间的联系可能取决于文化。

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自闭症特征与家庭功能之间的关系在自闭症儿童和非自闭症儿童中

作者：ten Hoopen, LW (ten Hoopen, Leontine W.); de Nijs, PFA (de Nijs, Pieter F. A.) ; Slappendel, G (Slappendel, Geerte); van der Ende, J (van der Ende, Jan) ; Bastiaansen, D (Bastiaansen, Dennis) ; Greaves-Lord, K (Greaves-Lord, Kirstin) ; Hakkaart-van Roijen, L (Hakkaart-van Roijen, Leona)  ; Hillegers, MHJ (Hillegers, Manon H. J.)

摘要：To explore associations between autism traits and family functioning over time, we studied longitudinal data of a mixed group of 168 clinically referred autistic and non-autistic children. Cross-lagged models showed a significant association between fewer autism traits at the diagnostic assessment and better family functioning 1 year later for the whole group, independently of children’s internalizing or externalizing behavior. When splitting the group into autistic children (58%) and non-autistic children (42%) based on an autism diagnosis, this association was only significant in the subgroup of non-autistic children with autism traits. We hypothesized that the needs of families experiencing difficulty understanding and adjusting to their children with autism traits, but no clinical autism diagnosis, might be unmet without the training or support facilities offered to families with autistic children. Although further research is needed to explore this association, clinicians may also consider supporting families of non-autistic children with autism traits to prevent family functioning problems. Because high autism trait levels in non-autistic children may be of a different origin than autism, for example, other neurodevelopmental or mental health problems, family training or support should be tailored to the child’s underlying difficulties. Lay Abstract Little is known about family functioning over time when raising a child with autism traits, with or without a clinical autism diagnosis. Therefore, we asked caregivers-mostly parents-of a group of 168 children about the family functioning and the child’s emotional and behavioral characteristics, as well as autistic traits, twice with about 1 year in between. For numerous reasons, the children were referred to youth mental health care centers, including child and adolescent psychiatric services. Care as usual was offered after the diagnostic assessment if a clinical diagnosis was the assessment outcome. Caregivers reported less problematic family functioning in children with fewer autism traits over time. The child’s additional emotional or behavioral characteristics did not seem to influence this relation. Furthermore, we split the whole group into autistic children with a clinical autism diagnosis (58%) and non-autistic children with autism traits but without a clinical diagnosis (42%) to see whether we would find the same results in both groups. Surprisingly, the relation between family functioning and the level of a child’s autism traits only held for the subgroup of non-autistic children with autism traits. Thus, raising children with autism traits without a clinical diagnosis may affect family functioning over time. We think that families might have difficulty understanding and adjusting to the autism traits of their children but are lacking the support that is exclusively offered to families of children with a clinical autism diagnosis. We must be cautious because we do not know whether there is a causal relation. Although further research is needed to explore and learn to understand this result, clinicians might consider offering support to families of children with subthreshold autism to prevent problems in family functioning. Because high autism trait levels in non-autistic children may be of a different origin than autism, for example, other neurodevelopmental or mental health problems, family training or support should be tailored to the child’s underlying difficulties.

为了探索自闭症特征与家庭功能之间的关联，我们研究了 168 名临床转诊的自闭症和非自闭症儿童的混合组的纵向数据。交叉滞后模型显示，诊断评估中较少的自闭症特征与1年后整个组的家庭功能较好之间存在显着关联，与儿童的内化或外化行为无关。当根据自闭症诊断将该组分为自闭症儿童（58%）和非自闭症儿童（42%）时，这种关联仅在具有自闭症特征的非自闭症儿童亚组中显着。我们假设，如果没有为有自闭症儿童的家庭提供的培训或支持设施，难以理解和适应具有自闭症特征但没有临床自闭症诊断的家庭的需求可能无法得到满足。虽然需要进一步的研究来探索这种关联，但临床医生也可以考虑支持具有自闭症特征的非自闭症儿童的家庭，以防止家庭功能问题。由于非自闭症儿童的高自闭症特质水平可能与自闭症不同，例如其他神经发育或心理健康问题，因此应根据儿童的潜在困难量身定制家庭培训或支持。外行摘要 在抚养具有自闭症特征的孩子时，无论是否被临床诊断为自闭症，对家庭功能随着时间的推移知之甚少。因此，我们向一组 168 名儿童的照顾者（主要是父母）询问了家庭功能、孩子的情绪和行为特征以及自闭症特征，两次之间大约有 1 年的时间。由于种种原因，这些儿童被转介到青少年精神保健中心，包括儿童和青少年精神科服务机构。如果临床诊断是评估结果，则在诊断评估后照常提供护理。照顾者报告说，随着时间的推移，自闭症特征较少的儿童的家庭功能问题较少。孩子的其他情绪或行为特征似乎并没有影响这种关系。此外，我们将整个组分为临床诊断为自闭症的自闭症儿童（58%）和具有自闭症特征但没有临床诊断的非自闭症儿童（42%），看看我们是否会在两组中找到相同的结果。令人惊讶的是，家庭功能与儿童自闭症特征水平之间的关系仅适用于具有自闭症特征的非自闭症儿童亚组。因此，在没有临床诊断的情况下抚养具有自闭症特征的儿童可能会随着时间的推移影响家庭功能。我们认为，家庭可能难以理解和适应孩子的自闭症特征，但缺乏专门为临床自闭症诊断儿童家庭提供的支持。我们必须谨慎，因为我们不知道是否存在因果关系。尽管需要进一步的研究来探索和学习理解这一结果，但临床医生可能会考虑为阈下自闭症儿童的家庭提供支持，以防止家庭功能问题。由于非自闭症儿童的高自闭症特质水平可能与自闭症不同，例如其他神经发育或心理健康问题，因此应根据儿童的潜在困难量身定制家庭培训或支持。

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Testing the social motivation theory of autism: the role of co-occurring anxiety

作者：Eloise Bagg, Hannah Pickard, Manting Tan, Tim J. Smith, Emily Simonoff, Andrew Pickles, Virginia Carter Leno, Rachael Bedford

摘要原文：Background

The Social Motivation Theory proposes that social reward processing differences underlie autism. However, low social motivation has also been linked to higher anxiety. Given the co-occurrence between autism and anxiety, it is possible that anxiety drives the association between social motivation and autistic characteristics. This study tests the mechanisms underlying the association between social motivation and autistic traits.

Methods

Participants were 165 adolescents (71 male), aged 10–16 years, from the Mapping profiles of cognition, motivation and attention in childhood (C-MAPS) study, enriched for autistic traits (70 participants with an autism diagnosis, 37 male). Participants completed a battery of online experimental tasks, including a Choose-a-Movie social motivation task and social cognition measures (theory of mind; emotion recognition), alongside parent-reported child anxiety and autistic traits.

Results

Higher social motivation was significantly associated with lower autistic traits (β = −.26, p < .001). Controlling for social cognition did not change the association between social motivation and autistic traits. Controlling for anxiety did significantly reduce the strength of the association (unstandardized coefficient change: p = .003), although social motivation remained associated with autistic traits (β = −.16, p = .004). Post hoc analyses demonstrated differential sex-effects: The association between social motivation and autistic traits was significant only in the females (β = −.38, p < .001), as was the attenuation by anxiety (unstandardized coefficient change: p < .001).

Conclusions

The association between social motivation and autistic traits could be partially attributed to co-occurring anxiety. Sex-specific effects found in females may be due to environmental factors such as increased social demands in adolescent female relationships. Results are consistent with self-report by autistic individuals who do not identify as having reduced social motivation.

摘要翻译：

背景

社会动机理论认为，社会奖励处理差异是自闭症的根源。然而，较低的社交动机也与较高的焦虑有关。鉴于自闭症和焦虑之间的共存，焦虑可能会驱动社会动机和自闭症特征之间的关联。这项研究测试了社会动机与自闭症特征之间关联的潜在机制。

方法

参与者为 165 名青少年（71 名男性），年龄 10-16 岁，来自儿童认知、动机和注意力映射概况 (C-MAPS)研究，丰富了自闭症特征（70 名被诊断为自闭症的参与者，37 名男性）。参与者完成了一系列在线实验任务，包括选择电影的社会动机任务和社会认知测量（心智理论；情绪识别），以及家长报告的儿童焦虑和自闭症特征。

结果

较高的社交动机与较低的自闭症特征显着相关（β  = -.26，p  < .001）。控制社会认知并没有改变社会动机和自闭症特征之间的关联。控制焦虑确实显着降低了关联强度（非标准化系数变化：p  = .003），尽管社交动机仍然与自闭症特征相关（β  = -.16，p  = .004）。事后分析证明了不同的性别影响：社会动机和自闭症特征之间的关联仅在女性中显着（β  = -.38，p  < .001），焦虑的衰减也是如此（非标准化系数变化：p  < .001）。 001）。

结论

社会动机和自闭症特征之间的关联可能部分归因于同时发生的焦虑。在女性中发现的性别特异性影响可能是由于环境因素造成的，例如青少年女性关系中社会需求的增加。结果与自闭症患者的自我报告一致，他们并不认为社交动机降低。

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