Gotham Katherine, Brunwasser Steven M, Lord Catherine
Vanderbilt University School of Medicine, Nashville.
Vanderbilt University Kennedy Center, Nashville.
J Am Acad Child Adolesc Psychiatry. 2015 May;54(5):369-76.e3. doi: 10.1016/j.jaac.2015.02.005. Epub 2015 Feb 17.
The objectives of this study were to model growth in anxiety and depressive symptoms from late school age through young adulthood in individuals with autism spectrum disorder (ASD) and controls with developmental delay (DD), and to assess relationships among internalizing growth patterns, participant characteristics, baseline predictors, and distal outcomes.
Data were collected between ages 6 and 24 years in 165 participants (n = 109 with ASD; n = 56 with nonspectrum DD), most of whom received diagnostic evaluations in both childhood and early adulthood. Questionnaires were collected approximately every 3 to 6 months between ages 9 and 24 years. Parent-rated Child Behavior Checklist (CBCL), Adult Behavior Checklist (ABCL), and Developmental Behaviour Checklist anxiety- and depression-related subscale distributions were modeled with mixed-effects Poisson models, covarying diagnosis, age, verbal IQ (VIQ), gender, and significant 2- and 3-way interactions.
Anxiety was positively associated with VIQ, and controlling for VIQ, both anxiety and depressive symptoms were greater in ASD than nonspectrum participants. Female gender predicted greater increases over time in anxiety and depressive symptoms for both diagnostic groups. Lower maternal education was associated with increasing internalizing symptoms in a subset of less verbal individuals with ASD. In exploratory post hoc analyses, internalizing symptoms were associated with poorer emotional regulation in school age, and with lower life satisfaction and greater social difficulties in early adulthood.
Findings support previous claims that individuals with ASD are at particular risk for affect- and anxiety-specific problems. Although symptom levels in females increase at a faster rate throughout adolescence, males with ASD appear to have elevated levels of depressive symptoms in school age that are maintained into young adulthood.
本研究的目的是对自闭症谱系障碍（ASD）个体和发育迟缓（DD）对照者从学龄晚期到青年期的焦虑和抑郁症状增长进行建模，并评估内化性增长模式、参与者特征、基线预测因素和远期结果之间的关系。
对165名参与者（n = 109名ASD患者；n = 56名非谱系DD患者）在6至24岁之间收集数据，其中大多数人在儿童期和成年早期都接受了诊断评估。在9至24岁之间大约每3至6个月收集一次问卷。采用混合效应泊松模型对家长评定的儿童行为检查表（CBCL）、成人行为检查表（ABCL）以及发育行为检查表中与焦虑和抑郁相关的子量表分布进行建模，同时考虑诊断、年龄、言语智商（VIQ）、性别以及显著的二阶和三阶交互作用。
焦虑与VIQ呈正相关，在控制VIQ后，ASD患者的焦虑和抑郁症状均比非谱系参与者更严重。女性性别预测两个诊断组的焦虑和抑郁症状随时间的增加幅度更大。较低的母亲教育程度与ASD中语言能力较弱的一部分人的内化症状增加有关。在探索性事后分析中，内化症状与学龄期较差的情绪调节有关，与成年早期较低的生活满意度和更大的社交困难有关。
研究结果支持了先前的观点，即ASD个体在情感和焦虑特定问题方面特别容易出现风险。尽管女性在整个青春期症状水平增长更快，但ASD男性在学龄期似乎有较高的抑郁症状水平，并持续到青年期。
