Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong.
Neurodevelopment and Psychosis Section, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Psychol Med. 2023 Jul;53(10):4788-4798. doi: 10.1017/S0033291722001787. Epub 2022 Aug 1.
Individuals with autism spectrum disorder (ASD) are challenged not only by the defining features of social-communication deficits and restricted repetitive behaviors, but also by a myriad of psychopathology varying in severity. Different cognitive deficits underpin these psychopathologies, which could be subjected to intervention to alter the course of the disorder. Understanding domain-specific mediating effects of cognition is essential for developing targeted intervention strategies. However, the high degree of inter-correlation among different cognitive functions hinders elucidation of individual effects.
In the Philadelphia Neurodevelopmental Cohort, 218 individuals with ASD were matched with 872 non-ASD controls on sex, age, race, and socioeconomic status. Participants of this cohort were deeply and broadly phenotyped on neurocognitive abilities and dimensional psychopathology. Using structural equation modeling, inter-correlation among cognitive domains were adjusted before mediation analysis on outcomes of multi-domain psychopathology and functional level.
While social cognition, complex cognition, and memory each had a unique pattern of mediating effect on psychopathology domains in ASD, none had significant effects on the functional level. In contrast, executive function was the only cognitive domain that exerted a generalized negative impact on every psychopathology domain ( factor, anxious-misery, psychosis, fear, and externalizing), as well as functional level.
Executive function has a unique association with the severity of comorbid psychopathology in ASD, and could be a target of interventions. As executive dysfunction occurs variably in ASD, our result also supports the clinical utility of assessing executive function for prognostic purposes.
自闭症谱系障碍（ASD）患者不仅存在社交沟通障碍和受限的重复行为等特征，还存在多种严重程度不同的精神病理学。这些精神病理学存在不同的认知缺陷，这些缺陷可以通过干预来改变疾病的进程。了解认知的特定领域的中介效应对于制定有针对性的干预策略至关重要。然而，不同认知功能之间的高度相关性阻碍了对个体效应的阐明。
在费城神经发育队列中，218 名 ASD 患者与 872 名非 ASD 对照在性别、年龄、种族和社会经济地位方面相匹配。该队列的参与者在神经认知能力和多维精神病理学方面进行了深入和广泛的表型分析。使用结构方程模型，在对多领域精神病理学和功能水平的结果进行中介分析之前，调整了认知领域之间的相关性。
尽管社会认知、复杂认知和记忆在 ASD 中的各个精神病理学领域都具有独特的中介效应模式，但它们对功能水平都没有显著影响。相比之下，执行功能是唯一对每个精神病理学领域（因子、焦虑痛苦、精神病、恐惧和外化）以及功能水平都具有普遍负面影响的认知领域。
执行功能与 ASD 中合并症精神病理学的严重程度具有独特的关联，可能是干预的目标。由于执行功能在 ASD 中存在差异，我们的结果也支持评估执行功能以进行预后目的的临床实用性。
