Autism Clinic for Translational Research, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050, Australia.
Youth Mental Health Unit, Brain and Mind Centre, Central Clinical School, Faculty of Medicine, University of Sydney, Camperdown, 2050, Australia.
Transl Psychiatry. 2018 Sep 24;8(1):200. doi: 10.1038/s41398-018-0193-8.
The disability burden in clinical cohorts with social impairment is significant, leading to poor functional outcomes. Some of this impairment has been linked to executive dysfunction. In this study, a transdiagnostic approach was taken to identify executive function (EF) processes in young adults that may underpin social impairment and to evaluate their contribution to disability. Comparisons were made between three prominent disorders that are characterized by social impairments, Autism Spectrum Disorder (ASD), Early Psychosis (EP) and Social Anxiety Disorder (SAD), as well as a neurotypically developing group (TYP). We examined whether overall disability could be predicted by neuropsychological and self-report assessments of EF. Our study showed that ASD participants demonstrated impaired performance on most domains of EF compared to the TYP group (mental flexibility, sustained attention and fluency) while the EP group showed impairment on sustained attention and attentional shifting. The SAD participants showed EF impairment on self-report ratings, even though their objective performance was intact. Self-reports of EF explained a significant percentage (17%) of disability in addition to the variance explained by other predictors, and this was particularly important for ASD. This is the first study to compare EF measures across clinical groups of social impairment and suggests unique cognitive-circuitry that underpins disability within groups. Impairments in EF were broad in ASD and predicted disability, EP impairments were specific to attentional processes and SAD impairments likely relate to negative self-monitoring. Self-report, as opposed to performance-based EF, provided best capacity to predict disability. These findings contribute to transdiagnostic circuitry models and intervention strategies.
在存在社交障碍的临床队列中，残疾负担是巨大的，这导致了较差的功能结果。其中一些障碍与执行功能障碍有关。在这项研究中，采用了一种跨诊断的方法来识别可能导致社交障碍的年轻成年人的执行功能（EF）过程，并评估它们对残疾的贡献。将三种以社交障碍为特征的突出障碍（自闭症谱系障碍（ASD）、早期精神病（EP）和社交焦虑障碍（SAD））与神经典型发育组（TYP）进行了比较。我们还检查了神经心理学和 EF 的自我报告评估是否可以预测整体残疾。我们的研究表明，与 TYP 组相比，ASD 参与者在 EF 的大多数领域表现出受损（心理灵活性、持续注意力和流畅性），而 EP 组在持续注意力和注意力转移方面表现出受损。SAD 参与者在自我报告的 EF 评分上表现出 EF 受损，尽管他们的客观表现是完整的。EF 的自我报告除了其他预测因素所解释的方差外，还解释了残疾的很大一部分（17%），这对于 ASD 尤为重要。这是首次比较具有社交障碍的临床群体中的 EF 测量，表明了独特的认知回路，为群体内的残疾提供了基础。ASD 中的 EF 损害广泛，并预测了残疾，EP 损害特定于注意力过程，SAD 损害可能与负面自我监测有关。与基于表现的 EF 相比，自我报告提供了预测残疾的最佳能力。这些发现为跨诊断电路模型和干预策略做出了贡献。
