Research Paper Example on Autism Spectrum Disorder

Introduction

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterised by impairments in social interaction and communication, and the presence of repetitive and restricted patterns of behaviour (Morrison 2017). A meta-analysis estimates that almost 40% of children with ASD are also diagnosed with an anxiety disorder or live with clinically elevated levels of anxiety (Van Steensel, Bofels & Perrin 2011). The overlapping characteristics of ASD and anxiety, such as repetitive behaviours, avoidance of social interactions and difficulties in communication, make it difficult to conduct differential diagnosis and assessment of the disorders (Duvekot, van der Ende, Verhulst & Greaves-Lord, 2018). The complex symptoms in co-morbid patients may also render standard interventions such as Cognitive Behavioral Therapy (CBT) inefficient (Duvekot et al. 2018).

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Research is needed to help us understand the overlap in symptoms between ASD and anxiety, to inform treatment and allow differential diagnoses. Emerging evidence suggests anxiety in early years may be a causal factor in later social communication impairment (Duvekot et al. 2018). However, little is understood about the cognitive factors that may underpin this relationship, and as yet, it is not clear how anxiety relates to the ASD symptoms concerning repetitive and restricted behaviour.

Obsessive Compulsive Disorder (OCD) is a specific type of anxiety disorder characterised by the presence of functionally-impairing obsessions and/or compulsions (Morrison 2017)). As the second most common anxiety disorder co-occurring with ASD, OCD affects an estimated 17% of children and adolescents with ASD (Van Steensel, Bofels & Perrin 2011). Here, there are clear overlaps in the repetitive and stereotyped behaviours associated with both OCD and ASD. Investigation of the cognitive factors underlying the specific co-morbidity with OCD may provide us with a fuller understanding of the aetiology of anxiety in ASD, with the potential to help clarify how anxiety relates to the symptoms of repetitive and restricted behaviour in addition to the overlap with anxiety more generally.

Aims and Objectives

The research aims at understanding the cognitive aspects that dictate the comorbidity of anxiety and ASD symptoms. In order to achieve this aim, the PhD project will:

• Review the current literature to inform the selection of cognitive factors of interest in the aetiology of co-morbid ASD and anxiety
• Assess the cognitive factors that explain variance and overlap in symptoms of ASD and anxiety in a secondary dataset
• Assess the cognitive factors that explain variance and overlap in symptoms of ASD and anxiety in a non-clinical population
• Assess the cognitive factors that explain variance and overlap in symptoms of ASD and anxiety in a clinical population of individuals with ASD and/or OCD

Literature Review

A brief review of the literature has identified two key areas of cognition that may help to explain the co-morbidity between ASD and anxiety. The first of these is executive functioning. Executive functioning is the central component of the information reception and processing system in the brain (Zandt, Prior & Kyrios, 2009). It is the system responsible for monitoring activity, directing attention and uniting information with actions. The second key area of cognition relates to individual differences in the preference to process information in a detail-oriented (local) or broader (global) manner.

Executive functioning is affected in both ASD and OCD, as well as in anxiety disorders more generally (Zandt et al. 2009). Research to date looking at the role of executive functioning in the overlap though is limited. In a study assessing a common pattern of genetic causal factors for both ASD and OCD, unaffected relatives showed poorer performance in planning, one of the five aspects of executive functioning measured (Delorme, Gousse, Roy, Trandafir, Mathieu, Mouren-Simeoni, & Leboyer, 2007). Previous research has shown that ASD and OCD have the potential of sharing common heritability patterns. The endophenotype responsible for ASD and OCD could be shared among relatives. Patients of the two disorders do not show impaired cognitive functioning but rather impaired organisation strategies. Research by Delorme et al., (2007) showed that OCD patients took more time to change their strategies after errors in the Tower of London task. Still, less is understood about the role of executive functioning for specific symptoms that are present in the two disorders. Zandt et al. (2009), aimed to identify and compare the role of executive functioning in the two disorders and ascertain whether there exists a relationship between repetitive behaviour and executive functioning in patients of OCD and ASD. The research employed the use of 54 respondents aged between 7 and 26 years. 19 of the respondents had ASD while 17 had OCD and 18 formed the control sample. The research found only limited support for the relationships between executive functioning and repetitive behaviour. However, comorbid aspects such as familial aggregation of probands in ASD and OCD patients indicate a relationship between EF and comorbidity of disorders.

Human beings direct attention based on global and local processing in their environments. Stimuli in the environment contain parts and details, which comprise local features, while the entirety of the stimuli makes up the global feature. ASD implicates the central coherence theory. Uta Frith developed the theory in 1989, and it defines central coherence as the ability of a person to examine details and decode meaning (Delli, Varveris & Geronta, 2017). Under the theory, people with ASD face difficulties in global processing. Such people excel more in picking out the extreme details from stimuli during local processing. Rankins, Bradshaw & Georgiou-Karistianis, (2005) researched the effect of pure OCD on processing in the local and global paradigms. The study observed that OCD patients showed significant difficulties in global processing and comprehension of hierarchical information. Emerging findings suggest there are cognitive factors involved in the co-morbidity, but more research is required to elucidate these further. An improved understanding would allow caregivers to improve diagnosis, assessment and treatment of ASD, OCD and other mental disorders.

Methodology

The research will employ quantitative methods to determine the extent of symptom overlap and the cognitive factors that explain these symptoms. The PhD will begin with a thorough review of the literature, building on the brief review above, which will inform the cognitive factors to be assessed in the empirical studies. Below, I set out the schedule for three empirical studies that will help to understand achieve the research aims.

Study 1: Analysis of secondary data set.

Very preterm children are at high risk for both ASD and anxiety disorders. Dr. Jenny Retzler has a dataset consisting of 65 7-to-11-year-olds born very preterm, and 48 7-to-11-year-olds born at term, in which anxiety and ASD symptoms were measured, and a comprehensive cognitive test battery was administered. The test battery included measures of basic cognitive processing, attention processing, and executive functioning. The first study would analyze this dataset to investigate cognitive factors associated with anxiety and ASD symptoms in this patient population. The results of this study, alongside the literature review, may be used to inform the selection of cognitions of interest for Studies 2 and 3.

Study 2: Data collection in a non-clinical population of children aged 7 to 11.

This study will assess cognitive factors underpinning symptoms observed in a non-clinical (and easy-to-recruit) population to help us understand the overlap at a sub-clinical level. Questionnaire measures of symptoms that are suitable for use in a non-clinical population will be used to assess the level of symptoms of ASD and anxiety (including OCD), and participants will complete cognitive tests. Analyses will determine the associations between different symptom domains and cognitive performance.

Study 3: Data collection in clinical population.

This study will build on the findings from Study 2, applying a similar methodology to a clinical population of individuals with ASD with and without comorbid anxiety disorders. The research experience of my supervisors within populations of children with neurodevelopmental disorders, alongside my own prior experience.

Experience

Experience with working with young people who have neurodevelopmental conditions will be particularly important when interacting with charities and participants during the recruitment and testing phase. Field-specific knowledge on gathering primary data from patients of mental disorders will further enable me to refine responses and eliminate common biases that are a significant impediment in primary research. For instance, understanding the vicious cycle of OCD enables researchers to anticipate responses in their respondents.

References

Bejerot, S. (2007). An autistic dimension: A proposed subtype of obsessive-compulsive disorder. Autism, 11(2), 101-110. DOI: 10.1177/1362361307075699

Delli, C. K. S., Varveris, A., & Geronta, A. (2017). Application of the Theory of Mind, Theory of Executive Functions and Weak Central Coherence Theory to Individuals with ASD. Journal of Educational and Developmental Psychology, 7(1). doi:10.5539/jedp.v7n1p102

Delorme, R., Gousse, V., Roy, I., Trandafir, A., Mathieu, F., Mouren-Simeoni, M. C., ... & Leboyer, M. (2007). Shared executive dysfunctions in unaffected relatives of patients with autism and obsessive-compulsive disorder. European Psychiatry, 22(1), 32-38. Retrieved from hal.inserm.fr/inserm-00125292

Delorme, R., Gousse, V., Roy, I., Trandafir, A., Mathieu, F., Mouren-Simeoni, M. C., ... & Leboyer, M. (2007). Shared executive dysfunctions in unaffected relatives of patients with autism and obsessive-compulsive disorder. European Psychiatry, 22(1), 32-38. Retrieved from hal.inserm.fr/inserm-00125292

Duvekot, J., van der Ende, J., Verhulst, F. C., & Greaves-Lord, K. (2018). Examining bidirectional effects between the autism spectrum disorder (ASD) core symptom domains and anxiety in children with ASD. Journal of Child Psychology and Psychiatry, 59(3), 277-284. Doi: 10.1111/jcpp.12829

Hill, T. L., Varela, R. E., Kamps, J. L., & Niditch, L. A. (2014). Local processing and social skills in children with Autism Spectrum Disorders: The role of anxiety and cognitive functioning. Research in Autism Spectrum Disorders, 8(9), 1243-1251.

Ivarsson, T., & Melin, K. (2008). Autism spectrum traits in children and adolescents with obsessive-compulsive disorder (OCD). Journal of anxiety disorders, 22(6), 969-978.

Leyfer, O. T., Folstein, S. E., Bacalman, S., Davis, N. O., Dinh, E., Morgan, J., ... & Lainhart, J. E. (2006). Comorbid psychiatric disorders in children with autism: interview development and rates of disorders. Journal of autism and developmental disorders, 36(7), 849-861.

Morrison, J., 2017. DSM-5 made easy: The clinician's guide to diagnosis. Guilford Publications.

Rankins, D., Bradshaw, J.L. and Georgiou-Karistianis, N., 2005. Local-global processing in obsessive-compulsive disorder and comorbid Tourette's syndrome. Brain and Cognition, 59(1), pp.43-51. Doi: 10.1016/j.bandc.2005.04.003

Snyder, H. R., Kaiser, R. H., Warren, S. L., & Heller, W. (2015). Obsessive-compulsive disorder is associated with broad impairments in executive function: A meta-analysis. Clinical Psychological Science, 3(2), 301-330. DOI: 10.1177/2167702.