Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom.
J Am Acad Child Adolesc Psychiatry. 2022 Dec;61(12):1445-1454. doi: 10.1016/j.jaac.2022.05.010. Epub 2022 Jun 13.
Despite the high prevalence of mental health difficulties in autistic youth, little is known about the patterns of developmental continuity and change in psychiatric symptoms between childhood and adolescence. Using a stratified community-derived sample of autistic youth (n = 101; 57 males, 44 females), within (homotypic) and between (heterotypic) domain associations between psychiatric symptoms in childhood to adolescence were tested as well as whether any continuities were moderated by sex, IQ, autism symptom severity, social economic status, or parental mental health.
Autistic youth were assessed for emotional, behavioral, and attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood (age 4-9 years) and adolescence (age 13-17 years) using parental diagnostic interview. Unadjusted and adjusted (accounting for the co-occurrence of psychiatric symptoms in childhood) weighted models tested homotypic and heterotypic associations between symptoms in childhood and adolescence. Moderation of significant pathways was tested using multigroup analysis.
Adolescent psychiatric symptoms all were predicted by symptoms of their childhood counterparts (emotional symptoms incidence rate ratio [IRR] = 1.06, 95% CI = 1.02-1.10, p < .01; behavioral symptoms IRR = 1.38, 95% CI = 1.21-1.59, p < .01; ADHD symptoms IRR = 1.11, 95% CI = 1.05-1.19, p < .01); the only heterotypic pathway that remained significant in adjusted analyses was from childhood emotional symptoms to adolescent ADHD symptoms (IRR = 1.04, 95% CI = 1.01-1.07, p = .02). Sex moderated the homotypic ADHD symptoms pathway; associations were significant in female participants only. Child IQ moderated the homotypic behavioral symptoms pathway; the association was stronger in youth with IQ <70.
Results from this community-based sample suggest that psychiatric symptoms in autistic youth exhibit substantial developmental continuity and thus highlight the importance of early screening and intervention. Sex and IQ may be important factors to consider when predicting likelihood of stability of ADHD and behavioral symptoms.
尽管自闭症青少年中精神健康问题的发病率很高，但对于儿童期和青春期之间精神症状的发展连续性和变化模式知之甚少。本研究使用分层的社区衍生自闭症青少年样本（n=101；57 名男性，44 名女性），测试了儿童期到青春期精神症状的同类型（同质型）和跨类型（异质型）之间的关联，以及任何连续性是否会受到性别、智商、自闭症症状严重程度、社会经济地位或父母精神健康的调节。
使用父母诊断访谈，对自闭症青少年在儿童期（4-9 岁）和青少年期（13-17 岁）的情绪、行为和注意力缺陷/多动障碍（ADHD）症状进行评估。未调整和调整（考虑到儿童期精神症状的共病）加权模型测试了儿童期和青少年期症状之间的同质型和异质型关联。使用多组分析测试了显著途径的调节作用。
青少年精神症状均由其童年期对应的症状预测（情绪症状发生率比 [IRR] = 1.06，95%CI = 1.02-1.10，p <.01；行为症状 IRR = 1.38，95%CI = 1.21-1.59，p <.01；ADHD 症状 IRR = 1.11，95%CI = 1.05-1.19，p <.01）；在调整分析中，唯一具有显著意义的异质型途径是从儿童期情绪症状到青少年期 ADHD 症状（IRR = 1.04，95%CI = 1.01-1.07，p =.02）。性别调节了同型 ADHD 症状途径；该关联仅在女性参与者中显著。儿童智商调节了同型行为症状途径；在智商 <70 的青少年中，该关联更强。
来自该社区样本的结果表明，自闭症青少年的精神症状表现出显著的发展连续性，因此突出了早期筛查和干预的重要性。性别和智商可能是预测 ADHD 和行为症状稳定性的重要因素。
