ارتباط میان علایم نژادی و همزمان در نوزادان و کودکان نو پا مبتلا به اختلال طیف اوتیسم

Researchers have indicated that persons with autism spectrum disorder (ASD) population evince higher rates of comorbid symptoms. While the relationship between comorbid symptoms and factors such as autism symptom severity, IQ level, age, communication abilities, and degree of social impairment were previously examined, there has been limited research on the effect of race in this area. The current study examined the potential role of race in comorbid symptoms in toddlers with ASD and atypically developing toddlers without a diagnosis of ASD using The Baby and Infant Screen for Children with aUtIsm Traits – Part 2 (BISCUIT-Part 2). Based on the current findings, African-American toddlers evinced higher rates of comorbid symptoms than Caucasian toddlers and toddlers of other races. In addition, toddlers with ASD evinced higher rates of comorbid symptoms than atypically developing toddlers without a diagnosis of ASD. Implications regarding these findings are discussed.

Autism Spectrum Disorder (ASD) is among the most common and the most researched pediatric disorders (Matson and Boisjoli, 2008 and Matson et al., 2008a). This may in part be due to ASD prevalence rates, which have significantly increased in recent years; it is now estimated that one in 88 children in the United States are diagnosed with the disorder (CDCP, 2012 and Matson and Kozlowski, 2011). Typical diagnosis of ASD occurs at 3–4 years of age; however, onset of symptoms occurs prior to 30 months of age (Lund and Jensen, 1989, Matson et al., 2008a, Matson et al., 2008b and Matson et al., 2008c). The core deficits of ASD involve qualitative impairments in social communication as well as the presence of repetitive behaviors and restricted interests (Fodstad et al., 2009, Matson and Boisjoli, 2007, Matson et al., 2008a, Matson et al., 2008b, Matson et al., 2008c, Matson et al., 2012, Matson and Wilkins, 2009 and Williams et al., 2013). In addition to associated symptoms such as cognitive impairment, deficits in adaptive functioning, feeding and sleep difficulties, and challenging behaviors (Jang et al., 2011, Kozlowski et al., 2012, Turygin et al., 2013 and Yerys et al., 2009), individuals with ASD are also frequently affected by at least one comorbid psychiatric disorder (de Bruin et al., 2007, Morgan et al., 2003 and Simonoff et al., 2008). In fact, researchers have found that individuals with ASD experience significantly more comorbid psychopathology and other impairments than peers with intellectual disabilities (Brereton et al., 2006, Smith and Matson, 2010a, Smith and Matson, 2010b and Smith and Matson, 2010c). For example, Simonoff et al. (2008) estimated that 70% of children with ASD had at least one comorbid disorder and 41% had two or more. Common co-occurring diagnoses are learning disorders, anxiety disorders, attention deficit hyperactivity disorder (ADHD), depression, and oppositional defiant disorder (ODD; Morgan et al., 2003, Simonoff et al., 2008 and White et al., 2009). The rate of anxiety disorders in the ASD population far exceeds the rate in the general population (Davis et al., 2010, de Bruin et al., 2007, Mayes et al., 2011a, Mayes et al., 2011b and White et al., 2009). Comorbidity estimates for anxiety in children with ASD have been found to be between 11% and 84% (de Bruin et al., 2007 and White et al., 2009). More specifically, researchers have found that individuals with ASD experience significantly more specific phobia, obsessions and compulsions, motor and vocal tics, and social anxiety than both typically and atypically developing peers (White et al., 2009). While most individuals with ASD evince some level of anxiety, the nature of the symptoms has been found to vary according to functioning level; individuals with high-functioning ASD are more likely to exhibit social worries while lower functioning children experience more obsessive-compulsive and avoidant symptoms (White et al., 2009). Other factors affecting anxiety rates in individuals with ASD include IQ and communication skills (Davis et al., 2012 and Weisbrot et al., 2005). Although previous diagnostic criteria have forbid the dual diagnosis of ASD and ADHD, the two conditions often co-occur (Leyfer et al., 2006, Tureck et al., 2013 and Yerys et al., 2009). Leyfer et al. (2006) found that 55% of individuals of ASD experience elevated symptoms of inattention and excessive hyperactivity. Additionally, 31% of individuals with ASD meet diagnostic criteria for ADHD. When ADHD co-occurs with ASD, symptoms of ASD are exacerbated; children with ASD and ADHD exhibit greater impairment in socialization, working memory, and adaptive skill compared to children with ASD alone (Matson et al., 2010 and Yerys et al., 2009). Individuals with comorbid ASD and ADHD also experience higher rates of internalizing and externalizing behaviors, tantrum behaviors, stereotypies, aggression, and destruction (Goldin et al., 2013, Matson et al., 2011 and Tureck et al., 2013). In addition, researchers have found that the rate of ODD is significantly greater in the autism population than in children with various other clinical diagnoses and typically developing children (Mayes et al., 2012). Researchers have estimated that ODD occurs in 37.2% of children with ASD (de Bruin et al., 2007). While the prevalence of ODD appears to decrease with age in the general population, individuals with comorbid ASD and ODD have been found to experience more permanent symptoms related to ODD (Mattila et al., 2010). Language ability is a significant factor affecting the rate of comorbid ODD diagnoses in individuals with ASD; verbal children were found to meet diagnostic criteria for ODD significantly more frequently than nonverbal children with ASD (Witwer & Lecavalier, 2010). While researchers have found high rates of such co-occurring disorders like anxiety, ADHD, and ODD, clinicians struggle to identify these comorbidities (Simonoff et al., 2008 and Volkmar and Cohen, 1991). Because many of the symptoms of co-occurring conditions overlap with the symptoms of ASD, they may be overshadowed. In addition, communication difficulties and intellectual disabilities common in individuals with ASD can make clinical interview challenging (Simonoff et al., 2008 and Volkmar and Cohen, 1991). Factors such as autism symptom severity, IQ level, age, communication abilities, and degree of social impairment have been correlated with various comorbid disorders in individuals with ASD (Davis et al., 2012, Mayes et al., 2011a, Mayes et al., 2011b and White et al., 2009). One area that has received little research attention is race and ethnicity. Therefore, the purpose of the current study was to explore the effect of race on the rate of comorbid symptoms in infants and toddlers with ASD. The comorbid conditions examined include tantrum/conduct behavior, inattention/impulsivity, avoidance behavior, anxiety/repetitive behavior, and eating/sleep problems.