Special considerations for assessing and caring for autism in girls and women.

PURPOSE OF REVIEW: As the specificities of autistic women are increasingly recognized, this review aims to highlight emerging areas of research. These areas primarily focus on measurement bias of diagnostic tools, the physical and mental health of autistic women, and the unique aspects of the lives of autistic women, both personally and professionally across all life stages. RECENT FINDINGS: Conventional diagnostic tools struggle to capture the specificities of autism in females, but more sensitive instruments like the GQ-ASC (Girls' Questionnaire for Autism Spectrum Conditions), later also referred to as Q-ASC (Questionnaire for Autism Spectrum Conditions) in the scientific literature, show better performances. Autistic women face particular challenges, including an increased risk of physical and mental health problems throughout their lives as women (puberty, motherhood, menopause). Autistic women also encounter specific difficulties in their employment that require greater consideration. SUMMARY: The findings of this review identify research areas that need to be developed to better understand and support autistic girls and women and to enhance clinical practice for them.

Adolescents With Eating Disorders in Pediatric Practice - The European Academy of Paediatrics Recommendations.

In the face of the growing number of adolescents suffering from eating disorders (EDs) and access to psychiatric care limited by the epidemiological and demographic situation, the primary care pediatrician's role in diagnosing and treating EDs is growing. The European Academy of Paediatrics (EAP) decided to summarize knowledge about EDs and formulate recommendations to support European pediatricians and improve care for adolescents with EDs.

Project Extension for Community Health Outcomes (ECHO) Autism: A Successful Model to Increase Capacity in Community-Based Care.

Individuals with autism spectrum disorder (ASD) struggle to access high-quality health care due to the shortage of trained providers. ECHO (Extension for Community Healthcare Outcomes) Autism is a unique educational program that allows ASD experts to provide knowledge and skills to professionals in local communities to deliver evidence-based care to children with ASD and their families. The model teaches clinicians how to screen and diagnose ASD, as well as manage common co-occurring medical and mental health issues. ECHO Autism is particularly useful for addressing the complex needs of children with ASD and reducing disparities often present in rural and underserved communities. The model can be disseminated globally due to its flexibility in accommodating local and regional differences in social norms and constructs. This article provides an overview of the format of the ECHO Autism model, data supporting the model's efficacy, and discusses future research directions.

Polish Adaptation of the Social Communication Questionnaire (SCQ) and Female Autism Phenotype: An Investigation of Potentially Sex-Biased Items in the Screening Assessment and Their Impact on Scores.

Standardized screening assessments and sex differences in autism spectrum disorder (ASD) are still under-explored in Poland. This study investigated the differences between Polish ASD females and males based on the responses provided by parents/caregivers to a Polish adaptation of the Social Communication Questionnaire, SCQ Lifetime and SCQ Current. The study included 90 ASD participants from Mental Health Services and Autism Clinics in Poland with no intellectual disability and no profound communication difficulties. Parents provided information on the SCQ items which were compared under three domains of the Autism Diagnostic Interview-Revised (ADI-R). Four SCQ items with the examples were investigated. No significant differences were found between the two sexes in the three domains. The repetitive use of objects declined with age in ASD males. Although the findings of the present study did not reveal substantial gender biases in the Polish adaptation of the SCQ, it is necessary to take into account potential gender differences in the clinical presentation of ASD and in the adaptation of screening and diagnostic tools.

Girls and women with autism. / Dziewczeta i kobiety z autyzmem.

Girls and women with autism are often undiagnosed, misdiagnosed or receive a diagnosis of autism at later age. This can result in adverse outcomes in their well-being, mental health, education, employment, and independence. The diagnosis of autism spectrum condition/disorder (hereinafter referred to as autism), with its current features linked with descriptions in the major diagnostic classification systems, is based primarily on observations and research on males. The term 'Autism Spectrum Condition' (ASC), used in this paper, has been coined by Simon Baron-Cohen and used in the professional literature for a decade to respect these individuals on the autism spectrum who feel that the term 'disorder'is stigmatizing, whereas ASC presents both the strengths of these people and difficulties they experience. The research shows that autism in females has unique symptomatology and manifests itself differently, more subtly, especially in high-functioning girls and women, i.e., those with fluent speech, average or above-average intelligence quotient. The research also shows diagnostic stereotypes and lack of required sensitivity to identify autistic females. Additionally they do not reflect the unique presentation of autism in females demonstrated by greater compensatory capacity and an ability to develop sophisticated methods of 'camouflaging'and masquerading. Furthermore, autism in females is associated with high comorbidity during adolescence including anxiety disorder, tic disorder, depression, high incidence of suicide, eating disorders, and high rates of other medical problems. Timely diagnosis, however, can reduce the difficulties that females with autism experience over their lifetime, allowing for the assessment of their needs regarding health, education, leisure, social relationships, and employment.

Emotional expression in psychiatric conditions: New technology for clinicians.

AIM: Emotional expressions are one of the most widely studied topics in neuroscience, from both clinical and non-clinical perspectives. Atypical emotional expressions are seen in various psychiatric conditions, including schizophrenia, depression, and autism spectrum conditions. Understanding the basics of emotional expressions and recognition can be crucial for diagnostic and therapeutic procedures. Emotions can be expressed in the face, gesture, posture, voice, and behavior and affect physiological parameters, such as the heart rate or body temperature. With modern technology, clinicians can use a variety of tools ranging from sophisticated laboratory equipment to smartphones and web cameras. The aim of this paper is to review the currently used tools using modern technology and discuss their usefulness as well as possible future directions in emotional expression research and treatment strategies. METHODS: The authors conducted a literature review in the PubMed, EBSCO, and SCOPUS databases, using the following key words: 'emotions,' 'emotional expression,' 'affective computing,' and 'autism.' The most relevant and up-to-date publications were identified and discussed. Search results were supplemented by the authors' own research in the field of emotional expression. RESULTS: We present a critical review of the currently available technical diagnostic and therapeutic methods. The most important studies are summarized in a table. CONCLUSION: Most of the currently available methods have not been adequately validated in clinical settings. They may be a great help in everyday practice; however, they need further testing. Future directions in this field include more virtual-reality-based and interactive interventions, as well as development and improvement of humanoid robots.

Autism spectrum disorder (ASD) in girls. Co-occurring psychopathology. Sex differences in clinical manifestation. / Zaburzenia ze spektrum autyzmu (ASD) u dziewczat. Wspólwystepujace zespoly psychopatologiczne. Róznice miedzyplciowe w obrazie klinicznym.

OBJECTIVES: The study aims to define the differences in clinical manifestation among adolescent girls and boys with autism spectrum disorder (ASD). METHODS: The study group consisted of 15 adolescent girls and 16 adolescent boys with diagnosis of autismor Asperger syndrome and their parents. Adolescents were assessed with ADOS (Autism Diagnostic Observation Schedule, Polish adaptation of the assessment), algorithms of ADOS and ADOS-2 (revised version) were compared. Structured interview was conducted with parents, they fulfilled AQ (Autism Quotient), ASAS (Australian Scale for Asperger Syndrome), GQ-ASC (Girls' Questionnaire for Autism Spectrum Conditions). Medical records were analyzed. Results were analyzed using statistical methods. RESULTS: Patients were assessed with ADOS Module 4. Results indicated statistically significant differences between ASD girls and ASD boys in communication section, both verbal and gestures. The mean scores of AQ for ASD girls and ASD boys were M = 33.0 and M=30.9, and of ASAS M =57% and M =61% respectively. ASD girls had more psychiatric hospitalisations than ASD boys (60% vs. 31%), and they were more often treated with antidepressants (67% vs. 31%), anxiolytics (20% vs. 6%), mood stabilizers (40% vs. 19%). ASD boys were more often treated with psychotropic medications (50% vs. 47%) and stimulants (44% vs. 20%) than ASD girls. CONCLUSIONS: ASD girls are at risk of receiving non-spectrum classification in ADOS or ADOS-2 while their developmental history and clinical manifestation confirm ASD. Clinical data suggests that ASD girls present more abnormalities in sensory profile. ASD girls are at greater risk for developing anxiety, depression, suicidal ideation, and for psychiatric hospitalization. ASD boys appear to be at greater risk for co-occurring ADHD, OCD and tics.

Profiling Autism Symptomatology: An Exploration of the Q-ASC Parental Report Scale in Capturing Sex Differences in Autism.

The Questionnaire for Autism Spectrum Conditions (Q-ASC) was developed by Attwood et al. (2011) to identify gender-sensitive profiles of autism symptomatology; prioritise and adjust the direction of clinical interventions; and support positive psychosocial outcomes and prognosis into adulthood. The current research piloted the Q-ASC with parents of 238 children with a clinical diagnosis of ASD-Level 1 (without intellectual or language impairment). Data analysis revealed eight interpretable and reliable components of the Q-ASC using Principle components analysis. Comparisons across age and gender groups found statistically significant mean differences of parent-reported characteristics. The findings from this study aim to identify improvements in the Q-ASC towards the future assessment of the sensitivity and diversity of presentations of autism among female children and adolescents.

An investigation of the 'female camouflage effect' in autism using a computerized ADOS-2 and a test of sex/gender differences.

BACKGROUND: Autism spectrum conditions (autism) are diagnosed more frequently in boys than in girls. Females with autism may have been under-identified due to not only a male-biased understanding of autism but also females' camouflaging. The study describes a new technique that allows automated coding of non-verbal mode of communication (gestures) and offers the possibility of objective, evaluation of gestures, independent of human judgment. The EyesWeb software platform and the Kinect sensor during two demonstration activities of ADOS-2 (Autism Diagnostic Observation Schedule, Second Edition) were used. METHODS: The study group consisted of 33 high-functioning Polish girls and boys with formal diagnosis of autism or Asperger syndrome aged 5-10, with fluent speech, IQ average and above and their parents (girls with autism, n = 16; boys with autism, n = 17). All children were assessed during two demonstration activities of Module 3 of ADOS-2, administered in Polish, and coded using Polish codes. Children were also assessed with Polish versions of the Eyes and Faces Tests. Parents provided information on the author-reviewed Polish research translation of SCQ (Social Communication Questionnaire, Current and Lifetime) and Polish version of AQ Child (Autism Spectrum Quotient, Child). RESULTS: Girls with autism tended to use gestures more vividly as compared to boys with autism during two demonstration activities of ADOS-2. Girls with autism made significantly more mistakes than boys with autism on the Faces Test. All children with autism had high scores in AQ Child, which confirmed the presence of autistic traits in this group. The current communication skills of boys with autism reported by parents in SCQ were significantly better than those of girls with autism. However, both girls with autism and boys with autism improved in the social and communication abilities over the lifetime. The number of stereotypic behaviours in boys significantly decreased over life whereas it remained at a comparable level in girls with autism. CONCLUSIONS: High-functioning females with autism might present better on non-verbal (gestures) mode of communication than boys with autism. It may camouflage other diagnostic features. It poses risk of under-diagnosis or not receiving the appropriate diagnosis for this population. Further research is required to examine this phenomenon so appropriate gender revisions to the diagnostic assessments might be implemented.

Autistic traits in male and female students and individuals with high functioning autism spectrum disorders measured by the Polish version of the Autism-Spectrum Quotient.

So far no standardized screening instrument for autism spectrum disorders for adults has been developed in Poland. The main aim of the study was to explore the properties of the Polish version of the Autism-Spectrum Quotient (AQ), especially its reliability and discriminating power. The second purpose was to establish whether the pattern of sex and area of study differences in the amount of autistic traits found in other countries also exist in Poland. The groups in the study included students (n = 2819), adults with ASD (n = 60) and a non-clinical sample (n = 60) matched with the ASD group for age, sex, education and place of residence. The Polish version of AQ proved to be reliable, although--as in studies conducted in other countries--the internal consistency coefficients for subscales (with exception for social skill) were low. ASD diagnosis was the most powerful determinant of AQ scores. Sex differences in autistic traits and a relationship between autistic traits and area of study were found.