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Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa

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Abstract

This study aimed to examine the presence of Autism Spectrum Disorder (ASD) in a sample of female adolescents with Anorexia Nervosa (AN) during the acute phase of illness. We also compare the level of autistic traits, social perception skills and obsessive–compulsive symptoms in four groups: AN, ASD, and two gender- and age-matched control groups. Of the 30 AN participants, only three scored above the conventional ADOS-2 threshold for ASD. The AN participants were similar to their controls on autistic trait measures, and to the ASD group on obsessive–compulsive measures, and on theory of mind ability and affect recognition measures. Further longitudinal studies are needed in order to determine the association between these conditions.

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References

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

    Book  Google Scholar 

  • Anckarsäter, H., Hofvander, B., Billstedt, E., Gillberg, I. C., Gillberg, C., Wentz, E., et al. (2012). The sociocommunicative deficit subgroup in anorexia nervosa: autism spectrum disorders and neurocognition in a community-based, longitudinal study. Psychological Medicine, 42, 1957–1967.

    Article  PubMed  Google Scholar 

  • Anderluh, M., Tchanturia, K., Rabe-Hesketh, S., Collier, D., & Treasure, J. (2009). Lifetime course of eating disorders: Design and validity testing of a new strategy to define the eating disorders phenotype. Psychological Medicine, 39, 105–114.

    Article  PubMed  Google Scholar 

  • Auyeung, B., Baron-Cohen, S., Wheelwright, S., & Allison, C. (2008). The autism spectrum quotient: Children’s version (AQ-Child). Journal of Autism and Developmental Disorders, 38, 1230–1240.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S., Hoekstra, R. A., Knickmeyer, R., & Wheelwright, S. (2006). The autism spectrum quotient (AQ)-adolescent version. Journal of Autism and Developmental Disorders, 36, 343–350.

    Article  PubMed  Google Scholar 

  • Baron-Cohen, S., Jaffa, T., Davies, S., Auyeung, B., Allison, C., & Wheelwright, S. (2013). Do girls with anorexia nervosa have elevated autistic traits? Molecular Autism, 4, 24.

    Article  PubMed  PubMed Central  Google Scholar 

  • Baron-Cohen, S., Wheelwright, S., Skinner, R., Martin, J., & Clubley, E. (2001). The autism spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. Journal of Autism and Developmental Disorders, 31, 5–17.

    Article  PubMed  Google Scholar 

  • Birmingham, C. L., & Beumont, P. J. V. (2004). A Practical handbook for healthcare professionals. Medical management of eating disorders. Cambridge: Cambridge University Press.

    Book  Google Scholar 

  • Calderoni, S., Fantozzi, P., Balboni, G., Pagni, V., Franzoni, E., Apicella, F., et al. (2015). The impact of internalizing symptoms on autistic traits in adolescents with restrictive anorexia nervosa. Neuropsychiatric Disease and Treatment, 11, 75–85.

    Article  PubMed  PubMed Central  Google Scholar 

  • Calderoni, S., Muratori, F., Leggero, C., Narzisi, A., Apicella, F., Balottin, U., et al. (2013). Neuropsychological functioning in children and adolescents with restrictive-type anorexia nervosa: an in-depth investigation with NEPSY-II. Journal of Clinical and Experimental Neuropsychology, 35(2), 167–179.

    Article  PubMed  Google Scholar 

  • Carton, A. M., & Smith, A. D. (2014). Assessing the relationship between eating disorder psychopathology and autistic traits in a non-clinical adult population. Eating and Weight Disorders, 19(3), 285–293.

    Article  PubMed  Google Scholar 

  • Chakraborty, K., & Basu, D. (2010). Management of anorexia and bulimia nervosa: an evidence-based review. Indian Journal of Psychiatry, 52(2).

  • Coombs, E., Brosnan, M., Bryant-Waugh, R., & Skevington, S. M. (2011). An investigation into the relationship between eating disorder psychopathology and autistic symptomatology in a non-clinical sample. British Journal of Clinical Psychology, 50, 326–338.

    Article  PubMed  Google Scholar 

  • Courty, A., Maria, A. S., Lalanne, C., Ringuenet, D., Vindreau, C., Chevallier, C., et al. (2013). Levels of autistic traits in anorexia nervosa: a comparative psychometric study. BMC Psychiatry, 13, 222.

    Article  PubMed  PubMed Central  Google Scholar 

  • Cuzzolaro, M., Vetrone, G., Marano, G., & Battacchi, M. (2000). Body uneasiness test (BUT) In L. Conti (Eds.), Repertorio delle scale di valutazione in psichiatria. Firenze: SEE.

  • Cuzzolaro, M., Vetrone, G., Marano, G., & Garfinkel, P. E. (2006). The body uneasiness test (BUT): Development and validation of a new body image assessment scale. Eating and Weight Disorders, 11, 1–13.

    Article  PubMed  Google Scholar 

  • De Bildt, A., Systema, S., Kraijer, D., & Minderaa, R. (2004). Prevalence of pervasive developmental disorders in children and adolescents with mental retardation. Journal of Child Psychology and Psychiatry, 46, 275–286.

    Article  Google Scholar 

  • Developmental Disabilities Monitoring Network Surveillance Year (2010). Principal Investigators; Centers for Disease Control and Prevention (CDC). (2014). Prevalence of autism spectrum disorder among children aged 8 years - autism and developmental disabilities monitoring network, 11 sites, United States, 2010. Morbidity and Mortality Weekly Report. Surveillance Summaries, 63(2), 1–21.

    Google Scholar 

  • Garner, D. M. (2004). Eating disorder inventory-3. Professional Manual. Lutz, FL: Psychological Assessment Resources, Inc.

    Google Scholar 

  • Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. (1982). The eating attitude test: psychometric features and clinical correlates. Psychological Medicine, 12(4), 871–878.

    Article  PubMed  Google Scholar 

  • Giannini, M., Pannocchia, L., Dalle Grave, R., Muratori, F., & Viglione, V. (2008). Eating Disorder Inventory-3. Firenze: Giunti OS.

    Google Scholar 

  • Gillberg, C., Råstam, M., & Gillberg, C. (1995). Anorexia nervosa 6 years after onset: Part I. Personality disorders. Comprehensive Psychiatry, 36, 61–69.

    Article  PubMed  Google Scholar 

  • Hambrook, D., Tchanturia, K., Schmidt, U., Russell, T., & Treasure, J. (2008). Empathy, systemizing, and autistic traits in anorexia nervosa: A pilot study. British Journal of Clinical Psychology, 47, 335–339.

    Article  PubMed  Google Scholar 

  • Head, A. M., McGillivray, J. A., & Stokes, M. A. (2014). Gender differences in emotionality and sociability in children with autism spectrum disorders. Molecular Autism, 5(1), 19.

    Article  PubMed  PubMed Central  Google Scholar 

  • Holtmann, M., Bolte, S., & Poustka, F. (2007). Autism spectrum disorders: Sex differences in autistic behavior domains and coexisting psychopathology. Developmental Medicine & Child Neurology, 49(5), 361–366.

    Article  Google Scholar 

  • Huke, V., Turk, J., Saeidi, S., Kent, A., & Morgan, J. F. (2013). Autism spectrum disorders in eating disorder populations: a systematic review. European Journal of Eating Disorders Review, 21(5), 345–351.

    Article  Google Scholar 

  • Huke, V., Turk, J., Saeidi, S., Kent, A., & Morgan, J. F. (2013). The clinical implications of high levels of autism Spectrum disorder features in anorexia nervosa: A pilot study. European Journal of Eating Disorders Review, 22(2), 116–121.

    Article  Google Scholar 

  • Hus, V., & Lord, C. (2014). The autism diagnostic observation schedule, Module 4: Revised algorithm and standardized severity scores. Journal of Autism and Developmental Disorders, 44(8), 1996–2012.

    Article  PubMed  PubMed Central  Google Scholar 

  • Korkman, M., Kirk, U., & Kemp, S. (2011). NEPSY– II. Italian adaptation. (2nd ed). Firenze: Giunti O.S. Organizzazioni Speciali.

  • Korkman, M., Kirk, U., & Kemp, S. L. (2007). NEPSY-II. Clinical and interpretative manual. San Antonio TX: Psychological Corporation.

    Google Scholar 

  • Lang, K., Dapelo, M. M., Khondoker, M., Morris, R., Surguladze, S., Treasure, J., & Tchanturia, K. (2015). Exploring emotion recognition in adults and adolescents with anorexia nervosa using a body motion paradigm. European Eating Disorders Review.

  • Lang, K., Lopez, C., Stahl, D., Tchanturia, K., & Treasure, J. (2014a). Central coherence in eating disorders: An updated systematic review and meta-analysis. The World Journal of Biological Psychiatry, 15(8), 586–598.

  • Lang, K., Stahl, D., Espie, J., Treasure, J., & Tchanturia, K. (2014b). Set shifting in children and adolescents with anorexia nervosa: An exploratory systematic review and meta-analysis. International Journal of Eating Disorders, 47(4), 394–399.

  • Lopez, C., Stahl, D., & Tchanturia, K. (2010). Estimated intelligence quotient in anorexia nervosa: A systematic review and meta-analysis of the literature. Annals in General Psychiatry, 9, 40.

    Article  Google Scholar 

  • Lord, C., Luyster, R., Gotham, K., & Guthrie, W. (2012). Autism diagnostic observation schedule, Second edition (ADOS-2) Manual (Part II): Toddler module. Torrance, CA: Western Psychological Services.

    Google Scholar 

  • Lord, C., Rutter, M., Di Lavore, P.C., Risi, S., & Gotham, K. (2012). ADOS-2: Autism diagnostic observation schedule. Los Angeles: Western Psychological Service.

    Google Scholar 

  • Lugnegard, T., Hallerback, M. U., & Gillberg, C. (2015). Asperger syndrome and schizophrenia: Overlap of self-reported autistic traits using the Autism-spectrum Quotient (AQ). Nordic Journal of Psychiatry, 69(4), 268–274.

    Article  PubMed  Google Scholar 

  • Mandy, W., Charman, T., Gilmour, J., & Skuse, D. (2011). Towards specifying pervasive developmental disorder unspecified. Autism Research, 4, 121–131.

    Article  PubMed  Google Scholar 

  • Mandy, W., & Tchanturia, K. (2015). Do women with eating disorders who have social and flexibility difficulties really have autism? A case series. Molecular Autism, 6, 6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mazzone, L., Postorino, V., De Peppo, L., Fatta, L., Lucarelli, V., Reale, L., et al. (2013). Mood symptoms in children and adolescents with autism spectrum disorders. Research in Developmental Disabilities, 34(11), 3699–3708.

    Article  PubMed  Google Scholar 

  • Mazzone, L., Ruta, L., & Reale, L. (2012). Psychiatric comorbidities in asperger syndrome and high functioning autism: diagnostic challenges. Annals of General Psychiatry, 11(1), 16.

    Article  PubMed  PubMed Central  Google Scholar 

  • Mehler, P. S., & Andersen, A. E. (1999). Eating disorders: A guide to medical care and complications. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Miller, J. S., Bilder, D., Farley, M., Coon, H., Pinborough-Zimmerman, J., Jenson, W., et al. (2012). Autism spectrum disorder reclassified: A second look at the 1980s Utah/UCLA autism epidemiologic study. Journal of Autism and Developmental Disorders, 43, 200–210.

    Article  Google Scholar 

  • Miller, K. K., Grinspoon, S. K., Ciampa, J., Hier, J., Herzog, D., & Klibanski (2005). A. medical findings in outpatients with anorexia nervosa. Archives of Internal Medicine, 165, 561–566.

    Article  PubMed  Google Scholar 

  • Mondschein, E. R., Adolph, K. E., & Tamis-LeMonda, C. S. (2000). Gender bias in mothers’ expectations about infant crawling. Journal of Experimental Child Psychology, 77(4), 304–316.

    Article  PubMed  Google Scholar 

  • Oldershaw, A., Hambrook, D., Tchanturia, K., Treasure, J., & Schmidt, U. (2010). Emotional theory of mind and emotional awareness in recovered anorexia nervosa patients. Psychosomatic Medicine, 72(1), 73–79.

    Article  PubMed  Google Scholar 

  • Pooni, J., Ninteman, A., Bryant-Waugh, R., Nicholls, D., & Mandy, W. (2012). Investigating autism spectrum disorder and autistic traits in early onset eating disorder. International Journal of Eating Disorders 45,4 583–591.

    Article  Google Scholar 

  • Postorino, V., Fatta L. M., De Peppo L., Giovagnoli G., Armando M., Vicari S., et al. (2015). Longitudinal comparison between male and female preschool children with autism spectrum disorder. Journal of Autism and Developmental Disorders, 45(7), 2046–2055.

    Article  PubMed  Google Scholar 

  • Råstam, M. (1992). Anorexia nervosa in 51 Swedish adolescents: Premorbid problems and comorbidity. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 5.

    Article  Google Scholar 

  • Råstam, M., Gillberg, C., & Wentz, E. (2003). Outcome of teenage onset anorexia nervosa in a Swedish-community based sample. European Child and Adolescent Psychiatry, 12, 78–90.

    Google Scholar 

  • Raven, J. C. (2008a). Standard Progressive Matrices. Firenze: Giunti Organizzazioni Speciali.

    Google Scholar 

  • Raven, J. C. (2008b). Colored Progressive Matrices. Firenze: Giunti Organizzazioni Speciali.

    Google Scholar 

  • Rhind, E., Bonfioli, R., Hibbs, E., Goddard, P., Macdonald, S., Gowers, U., et al. (2014). An examination of autism spectrum traits in adolescents with anorexia nervosa and their parents. Molecular Autism, 5, 56.

    Article  PubMed  PubMed Central  Google Scholar 

  • Roberts, M. E., Tchanturia, K., Stahl, D., Southgate, L., & Treasure, J. (2007). A systematic review and meta-analysis of set-shifting ability in eating disorders. Psychological Medicine, 37(8), 1075–1084.

    Article  PubMed  Google Scholar 

  • Russell, G., Steer, C., & Golding, J. (2011). Social and demographic factors that influence the diagnosis of autistic spectrum disorders. Social Psychiatry and Psychiatric Epidemiology, 46, 1283–1293.

    Article  PubMed  Google Scholar 

  • Russell, T. A., Schmidt, U., Doherty, L., Young, V., & Tchanturia, K. (2009). Aspects of social cognition in anorexia nervosa: affective and cognitive theory of mind. Psychiatry Research, 168(3), 181–185.

    Article  PubMed  Google Scholar 

  • Ruta, L., Mazzone, D., Mazzone, L., Wheelwright, S., & Baron-Cohen, S. (2012). The Autism-Spectrum Quotient-Italian version: a cross-cultural confirmation of the broader autism phenotype. Journal of Autism and Developmental Disorders, 42, 625–633.

    Article  PubMed  Google Scholar 

  • Scahill, L., Riddle, M. A., McSwiggin-Hardin, M., Ort, S. I., King, R. A., Goodman, W. K., et al. (1997). Children’s Yale- Brown Obsessive Compulsive Scale: reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36(6), 844–852.

    Article  PubMed  Google Scholar 

  • Solomon, M., Ozonoff, S. J., Cummings, N., & Carter, C. S. (2008). Cognitive control in autism spectrum disorders. International Journal of Developmental Neuroscience: The Official Journal of the International Society for Developmental Neuroscience, 26, 239–247.

    Article  Google Scholar 

  • Storch, E. A., Murphy, T. K., Adkins, J. W., Lewin, A. B., Geffken, G. R., Johns, N. B., et al. (2006). The children’s Yale-brown obsessive–compulsive scale: Psychometric properties of child-and parent report formats. Journal of Anxiety Disorders, 20(8), 1055–1070.

    Article  PubMed  Google Scholar 

  • Szatmari, P., Liu, X. Q., Goldberg, J., Zwaigenbaum, L., Paterson, A. D., Woodbury-Smith, M., et al. (2012). Sex differences in repetitive stereotyped behaviors in autism: implications for genetic liability. American. Journal of Medical Genetics. Part B. Neuropsychiatric Genetics, 159(B1), 5–12.

    Article  Google Scholar 

  • Tchanturia, K., Davies, H., Harrison, A., Roberts, M., Nakazato, M., Schmidt, U., et al. (2012). Poor cognitive flexibility in eating disorders: examining the evidence using the Wisconsin Cart Sorting Task. PLoS ONE, 7(1), e28331.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tchanturia, K., Doris, E., & Fleming, C. (2014). Effectiveness of cognitive remediation and emotion skills training (CREST) for anorexia nervosa in group format: a naturalistic pilot study. European Eating Disorders Review, 22(3), 200–205.

    Article  PubMed  Google Scholar 

  • Tchanturia, K., Happé, F., Godley, J., Treasure, J., Bara-Carril, N., & Schmidt, U. (2004). “Theory of mind” in anorexia nervosa. European Eating Disorder Review, 12, 361–366.

    Article  Google Scholar 

  • Tchanturia, K., Harrison, A., Davies, H., Roberts, M., Oldershaw, A., Nakazato, M., et al. (2011). Cognitive flexibility and clinical severity in eating disorders. PLoS ONE, 6(6), e20462.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tchanturia, K., Smith, E., Weineck, F., Fidanboylu, E., Kern, N., Treasure, J., et al. (2013). Exploring autistic traits in anorexia: A clinical study. Molecular Autism, 4, 44.

    Article  PubMed  PubMed Central  Google Scholar 

  • Urgesi, C., Campanella, F., & Fabbro, F. (2011). NEPSY–II. Second edition. Contributo alla taratura italiana (NEPSY–II. Second edition. Italian Standardization). Firenze. Italy: Giunti O.S. Organizzazioni Speciali.

  • Van Wijngaarden-Cremers, P.J., van Eeten, E., Groen, W.B., Van Deurzen, P.A., Oosterling, I.J., & Van der Gaag, R.J. (2013). Gender and age differences in the core triad of impairments in autism spectrum disorders: A systematic Review and meta-analysis. Journal of Autism and Developmental Disorders, 30.

  • Wentz Nilsson, E., Gillberg, C., & Råstam, M. (1998). Familial factors in anorexia nervosa: A community-based study. Comprehensive Psychiatry, 39, 392–399.

    Article  Google Scholar 

  • Wentz Nilsson, E., Lacey, J. H., Waller, G., Rastam, M., Turk, J., & Gillberg, C. (2005). Childhood onset neuropsychiatric disorders in adults eating disorder patients. A pilot study. European Child and Adolescent Psychiatry, 14, 431–437.

    Article  Google Scholar 

  • Westwood, H., Eisler, I., Mandy, W., Leppanen, J., Treasure, J., & Tchanturia, K. (2015). Using the autism-spectrum quotient to measure autistic traits in anorexia nervosa: A systematic review and meta-analysis. Journal of Autism and Developmental Disorders, 46(3), 964–977.

    Article  PubMed Central  Google Scholar 

  • Whitehouse, A. J. O., Hickey, M., & Ronald, A. (2011). Are autistic traits in the general population stable across development? PLoS ONE, 6(8), e23029.

    Article  PubMed  PubMed Central  Google Scholar 

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Author Contribution

VP designed, conducted, supervised the study and wrote the manuscript, LS interpreted the data, corrected drafts, and helped in the writing process, LDP, LMF, VZ, and MCC helped in the recruitment and in the data collection process, SG performed the analysis, interpreted the data and helped with the revisions of the manuscript; SV assisted in the write up of the study; LM designed and supervised the project, and revised the draft of the manuscript.

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Correspondence to Valentina Postorino.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Postorino, V., Scahill, L., De Peppo, L. et al. Investigation of Autism Spectrum Disorder and Autistic Traits in an Adolescent Sample with Anorexia Nervosa. J Autism Dev Disord 47, 1051–1061 (2017). https://doi.org/10.1007/s10803-016-3023-y

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