Dinkler Lisa, Taylor Mark J, Råstam Maria, Hadjikhani Nouchine, Bulik Cynthia M, Lichtenstein Paul, Gillberg Christopher, Lundström Sebastian
Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
J Child Psychol Psychiatry. 2021 Mar;62(3):316-326. doi: 10.1111/jcpp.13265. Epub 2020 Jun 4.
Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN.
In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18).
We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems.
Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.
神经性厌食症（AN）与自闭症谱系障碍（ASD）在表型和病因上可能存在关联。然而，由于缺乏前瞻性研究，目前尚不清楚AN患者的自闭症特征在幼儿期是否明显。在此，我们对首次诊断AN之前和之后的自闭症特征进行了前瞻性研究。
在瑞典儿童和青少年双胞胎研究中，以5987名个体（52.4%为女性）为基于人群的样本，父母报告了孩子在9岁和18岁时的自闭症特征。从瑞典国家患者登记处获取AN和ASD的诊断信息。此外，通过父母报告的AN治疗情况确定AN诊断。我们比较了首次诊断AN之前（9岁）和之后（18岁）患有和未患有AN的个体在自闭症特征方面是否存在差异。
我们没有发现证据表明后来被诊断为AN的9岁儿童的自闭症特征有所增加。然而，在18岁时，受限/重复行为和兴趣有明显增加，但仅在急性AN患者亚组中。社交沟通问题的增加不太明显。
ASD患者的应对策略以及女性ASD表型的一些差异可能解释了为什么我们没有在后来发展为AN的儿童中发现自闭症特征增加。或者，也有可能在AN发病之前自闭症特征并未出现，从而对先前报道的AN中ASD患病率升高提出质疑。未来的研究应采用针对性的测量方法，以调查AN患者的自闭症特征是否最好被概念化为急性AN阶段的一种附带现象，或者这些症状是否确实代表了可临床验证的神经发育障碍ASD。
