Lukito Steve, Jones Catherine R G, Pickles Andrew, Baird Gillian, Happé Francesca, Charman Tony, Simonoff Emily
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
School of Psychology, Cardiff University, Cardiff, UK.
Mol Autism. 2017 Nov 9;8:60. doi: 10.1186/s13229-017-0177-1. eCollection 2017.
Individuals with autism spectrum disorder (ASD) frequently demonstrate symptoms of attention-deficit/hyperactivity disorder (ADHD). Previous findings in children with ASD have suggested that these symptoms are associated with an impairment in executive function (EF) abilities. However, studies rarely considered this association within a single framework that controls for other related factors such as Theory of Mind (ToM) abilities and ASD symptoms.
We used structural equation modeling to explore the relations among EF, ToM, and symptoms of ASD and ADHD, using data from a population-based sample of 100 adolescents with ASD and full-scale IQ ≥ 50 (the Special Needs and Autism Project (SNAP) cohort). The study used a multi-measure and multi-informant approach, where performance of inhibition, planning, switching, and working memory tasks indexed EF and performance on tasks involving mentalizing indexed ToM. Measures of ASD and ADHD symptoms included parent and teacher reports and direct observation of the children. Shared source of symptom reporting was accounted for with a parental rating latent factor indexed by symptom measures reported by parents.
Impairments in EF abilities were specifically associated with ADHD symptoms while impaired ToM was specifically associated with ASD symptoms, when accounting for the associations of each cognitive domain with the other factors. ASD and ADHD symptom latent factors were also correlated, but this association became nonsignificant once the shared source of reporting from parents was accounted for and within a model that also controlled for the correlated pathway between EF and ToM factors. The specific relations between the cognitive domains and behavioral symptoms remained even after controlling for IQ.
In this ASD sample, symptoms of ADHD and ASD are underpinned by separate cognitive domains. The association between EF and ToM impairments is a likely partial explanation for the co-occurrence of ADHD symptoms in ASD, but the role of shared reporting effects is also important and supports the inclusion of independent informants and objective measures in future research.
自闭症谱系障碍（ASD）患者经常表现出注意力缺陷/多动障碍（ADHD）的症状。先前对ASD儿童的研究表明，这些症状与执行功能（EF）能力受损有关。然而，很少有研究在控制其他相关因素（如心理理论（ToM）能力和ASD症状）的单一框架内考虑这种关联。
我们使用结构方程模型来探究EF、ToM以及ASD和ADHD症状之间的关系，数据来自100名ASD青少年且全量表智商≥50的基于人群的样本（特殊需求与自闭症项目（SNAP）队列）。该研究采用多测量和多 informant 方法，其中抑制、计划、转换和工作记忆任务的表现索引EF，涉及心理化任务的表现索引ToM。ASD和ADHD症状的测量包括家长和教师报告以及对儿童的直接观察。症状报告的共享来源通过家长报告的症状测量索引的家长评分潜在因素来解释。
在考虑每个认知领域与其他因素的关联时，EF能力受损与ADHD症状特别相关，而ToM受损与ASD症状特别相关。ASD和ADHD症状潜在因素也相关，但一旦考虑了家长报告的共享来源并且在一个也控制了EF和ToM因素之间相关途径的模型中，这种关联就变得不显著了。即使在控制智商之后，认知领域与行为症状之间的特定关系仍然存在。
在这个ASD样本中，ADHD和ASD症状由不同的认知领域支撑。EF和ToM受损之间的关联可能是ASD中ADHD症状共现的部分解释，但共享报告效应的作用也很重要，并支持在未来研究中纳入独立 informant 和客观测量。
