Divisions of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Transl Psychiatry. 2019 Nov 13;9(1):298. doi: 10.1038/s41398-019-0614-3.
The neural correlates distinguishing youth with Autism Spectrum Disorder (ASD-) and ASD with co-occurring Attention Deficit Hyperactivity Disorder (ASD+) are poorly understood despite significant phenotypic and prognostic differences. Paired-pulse transcranial magnetic stimulation (TMS) measures, including intracortical facilitation (ICF), short interval cortical inhibition (SICI), and cortical silent period (CSP) were measured in an age matched cohort of youth with ASD- (n = 20), ASD + (n = 29), and controls (TDC) (n = 24). ASD- and ASD+ groups did not differ by IQ or social functioning; however, ASD+ had significantly higher inattention and hyperactivity ratings. ICF (higher ratio indicates greater facilitation) in ASD+ (Mean 1.0, SD 0.19) was less than ASD- (Mean 1.3, SD 0.36) or TDC (Mean 1.2, SD 0.24) (F2,68 = 6.5, p = 0.003; post-hoc tests, ASD+ vs either TDC or ASD-, p ≤ 0.05). No differences were found between groups for SICI or age corrected active/resting motor threshold (AMT/RMT). Across all ASD youth (ASD- and ASD+), ICF was inversely correlated with worse inattention (Conners-3 Inattention (r = -0.41; p < 0.01) and ADHDRS-IV Inattention percentile (r = -0.422, p < 0.01) scores. ICF remains intact in ASD- but is impaired in ASD+. Lack of ICF is associated with inattention and executive function across ASD. Taken with the present findings, ADHD may have a distinct electrophysiological "signature" in ASD youth. ICF may constitute an emerging biomarker to study the physiology of ADHD in ASD, which may align with disease prognosis or treatment response.
尽管自闭症谱系障碍（ASD）伴发注意缺陷多动障碍（ASD+）患者在表型和预后方面存在显著差异，但目前对其神经相关性仍知之甚少。我们在年龄匹配的 ASD-（n=20）、ASD+（n=29）和对照组（TDC）（n=24）青年人群中测量了包括皮质内易化（ICF）、短程皮质抑制（SICI）和皮质静息期（CSP）在内的成对脉冲经颅磁刺激（TMS）指标。ASD-和 ASD+组在智商或社交功能方面无差异；然而，ASD+组的注意力不集中和多动评分明显更高。ASD+（均值 1.0，SD 0.19）的 ICF（比值越高表示易化程度越高）低于 ASD-（均值 1.3，SD 0.36）或 TDC（均值 1.2，SD 0.24）（F2,68=6.5，p=0.003；事后检验，ASD+与 TDC 或 ASD-相比，p≤0.05）。三组间 SICI 或年龄校正主动/静息运动阈值（AMT/RMT）无差异。在所有 ASD 青少年（ASD-和 ASD+）中，ICF 与注意力不集中程度呈负相关（Conners-3 注意力不集中（r=-0.41；p<0.01）和 ADHD-RS-IV 注意力不集中百分位数（r=-0.422，p<0.01）评分。ASD-患者的 ICF 保持完整，但 ASD+患者的 ICF 受损。ASD 中缺乏 ICF 与注意力不集中和执行功能有关。结合目前的研究结果，ADHD 在 ASD 青少年中可能具有独特的电生理“特征”。ICF 可能成为研究 ASD 中 ADHD 生理学的新兴生物标志物，该标志物可能与疾病预后或治疗反应相关。
