Parental Expressed Emotion and Behavioural Outcomes in Autistic Children and Adolescents: A Systematic Review.

Growing interest in the links between parent-child relationships and child behavioural presentations in families of autistic children has led to an increased use of the Five Minute Speech Sample (FMSS) measure of parental expressed emotion (EE) in autism research. This review focuses on studies exploring the relationships between parental EE and behavioural outcomes in autistic children. Electronic searches of six databases and grey literature wielded eight studies that met eligibility criteria. Study designs were a mixture of cross-sectional and longitudinal and quality of studies was variable. Parental criticism was largely positively related to, and showed some predictive value for, child behaviour problems. Warmth was mostly negatively related to, and showed some predictive value for, child behaviour problems. Preliminary evidence from one study showed paternal warmth to be significantly related to child behaviours, whilst child behaviours were also significantly related to paternal warmth, suggesting a bidirectional relationship. Analysis of additional EE components produced variable results, however parental stress and depressive symptoms were consistently related to child behaviour, and preliminary evidence suggests a possible role of maternal education level and family cohesion. Outcomes were variable across FMSS coding systems and greater consistency in their application is needed in future research. The current findings suggest that parental EE has an important relationship with child behaviour and future intervention efforts may benefit from aiming to reduced EE in order to improve child outcomes.

Schizotypy and emotional memory.

BACKGROUND: Emotional dysfunction is a core feature of psychotic disorders. One expression of such dysfunction is a reduction of the emotion-induced enhancement of memory which is normally found in healthy individuals. Less severe disruption of emotional processing may also be present in individuals prone to 'unusual' psychosis-like experiences. In this study we investigate voluntary declarative (i.e. explicit or episodic) emotional memory performance, primarily in relation to positive schizotypy (as measured by the unusual experiences scale of the O-LIFE). The effect of negative schizotypy (introvertive anhedonia scale of the O-LIFE) was also explored. We hypothesized that schizotypal individuals (scoring highly on Unusual Experiences) would show reduced memory enhancement. METHODS: One hundred and two healthy participants viewed a narrated slide-show containing neutral and negative emotional content. They rated the story on a number of affective dimensions and completed a variety of trait measures, including a multi-dimensional measure of schizotypy. Seven days later, a memory test was performed and frequency of involuntary memories related to the slide-show assessed. RESULTS: The voluntary declarative emotional memory advantage in recall seen in low scorers (25%ile) on unusual experiences was absent in high scorers (75%ile), despite greater subjective fearfulness and emotionality in that group. However, the high scoring group did report experiencing more involuntary memories related to the story. There was no effect of negative schizotypy on declarative emotional memory. CONCLUSIONS: The emotional memory difficulties seen in studies of schizophrenia may extend to those with a vulnerability to positive psychosis-like experiences. This vulnerability may be expressed in both voluntary declarative - as well as involuntary - emotional memory performance.

Persistent nigrostriatal dopaminergic abnormalities in ex-users of MDMA ('Ecstasy'): an 18F-dopa PET study.

Ecstasy (±3,4-methylenedioxymethamphetamine, MDMA) is a popular recreational drug with known serotonergic neurotoxicity. Its long-term effects on dopaminergic function are less certain. Studying the long-term effects of ecstasy is often confounded by concomitant polydrug use and the short duration of abstinence. We used (18)F-dopa positron emission tomography (PET) to investigate the long-term effects of ecstasy on nigrostriatal dopaminergic function in a group of male ex-recreational users of ecstasy who had been abstinent for a mean of 3.22 years. We studied 14 ex-ecstasy users (EEs), 14 polydrug-using controls (PCs) (matched to the ex-users for other recreational drug use), and 12 drug-naive controls (DCs). Each participant underwent one (18)F-dopa PET, cognitive assessments, and hair and urinary analyses to corroborate drug-use history. The putamen (18)F-dopa uptake of EEs was 9% higher than that of DCs (p=0.021). The putamen uptake rate of PCs fell between the other two groups, suggesting that the hyperdopaminergic state in EEs may be due to the combined effects of ecstasy and polydrug use. There was no relationship between the amount of ecstasy used and striatal (18)F-dopa uptake. Increased putaminal (18)F-dopa uptake in EEs after an abstinence of >3 years (mean) suggests that the effects are long lasting. Our findings suggest potential long-term effects of ecstasy use, in conjunction with other recreational drugs, on nigrostriatal dopaminergic functions. Further longitudinal studies are required to elucidate the significance of these findings as they may have important public health implications.

Brain serotonin transporter binding in former users of MDMA ('ecstasy').

BACKGROUND: Animal experimental studies have prompted concerns that widespread use of 3,4-methylenedioxymethamphetamine (MDMA; 'ecstasy') by young people may pose a major public health problem in terms of persistent serotonin neurotoxicity. AIMS: To determine the status of brain serotonin neurons in a group of abstinent MDMA users. METHOD: We assessed the integrity of brain serotonin neurons by measuring serotonin transporter (SERT) binding using positron emission tomography (PET) and [(11)C]DASB in 12 former MDMA users, 9 polydrug users who had never taken MDMA and 19 controls who reported no history of illicit drug use. RESULTS: There was no significant difference in the binding potential of [(11)C]DASB between the groups in any of the brain regions examined. CONCLUSIONS: To the extent that [(11)C]DASB binding provides an index of the integrity of serotonin neurons, our findings suggest that MDMA use may not result in long-term damage to serotonin neurons when used recreationally in humans.

Ecstasy (MDMA) does not have long-term effects on aggressive interpretative bias: a study comparing current and ex-ecstasy users with polydrug and drug-naive controls.

+/-3, 4-methylenedioxymethamphetamine (MDMA or ecstasy) remains a widely used recreational drug, which, in animals, can produce long-lasting changes to the brain's serotonergic system. As serotonin has been implicated in human aggression, it is possible that ecstasy users are at risk of increased aggression even after prolonged abstention from the drug. The objective of this study was to indirectly assess aggression in current and abstinent ecstasy users using an information-processing paradigm that measures cognitive bias toward material with aggressive content. The task employed has previously shown increased aggressive bias 3-4 days after ecstasy use. An interpretative bias task was administered to 105 male participants: 26 ex-ecstasy users, 25 current ecstasy users, 29 polydrug using controls, and 25 drug-naive controls. Accuracy and response times to process and recognize ambiguous sentences were tested. There were no group differences in aggressive interpretative bias. All 4 groups processed neutral sentences faster than aggressive sentences and were subsequently faster and more confident in recognizing neutral compared with aggressive sentences. Further, self-ratings of aggression also showed no group differences, even though self-rated impulsivity was significantly higher in current ecstasy users than in drug-naive controls. The findings that all groups were biased toward neutral and away from aggressive interpretations of ambiguous sentences add to the existing body of knowledge in suggesting that increased aggression found in ecstasy users a few days after taking the drug is a transient phenomenon and not a long-term, persisting effect.

Neurocognitive function in current and ex-users of ecstasy in comparison to both matched polydrug-using controls and drug-naïve controls.

RATIONALE: Despite years of research and much controversy surrounding the effects of ecstasy use, findings are equivocal. Attempting to reduce methodological problems, such as concurrent use of other recreational drugs, could lead to a clearer picture of the effects of ecstasy use on cognitive function. OBJECTIVES: The aim of this study is to investigate the effects of both prolonged abstention from ecstasy use and current use on cognitive function while controlling for the regular use of other recreational drugs used by ecstasy users (alcohol, cannabis, cocaine, amphetamines and lysergic acid diethylamide). MATERIALS AND METHODS: A range of cognitive functions (including working memory, episodic memory, verbal learning and executive functions) was assessed in 109 participants: 25 current ecstasy users, 28 ex-ecstasy users (abstinent for at least 1 year), 29 polydrug-using controls (matched to both ecstasy-using groups for the use of other recreational drugs) and 27 drug-naïve controls. RESULTS: There was an overall tendency for impaired verbal learning and memory in both current ecstasy users and polydrug controls. There was also evidence of reduced response inhibition in the current ecstasy users and polydrug controls, which appeared to be related to recency of drug use. However, the majority of tests showed no group differences. CONCLUSIONS: The results suggest that recreational drug use in general, rather than ecstasy use per se, can lead to subtle cognitive impairments and that recent drug use appears to impact strongest on cognitive performance. This study highlights the importance of controlling for the use of all recreational drugs and, in particular, recent drug use when investigating 'effects of ecstasy' on cognitive function.

Enhanced recognition of facial expressions of disgust in opiate users receiving maintenance treatment.

AIMS: Accurate recognition of facial expressions of emotion is critical in interpersonal interaction but is impaired in alcoholics, even after a period of abstinence. Little is known of whether other drug-dependent populations also show these impairments. This study aimed to investigate facial expression recognition by chronic opiate users. DESIGN: An independent group design was used to compare 20 participants receiving opiate substitution treatment, 20 ex-opiate users in rehabilitation (average abstinence of 6 months) and 21 unemployed healthy controls. MEASUREMENTS: The accuracy and speed of recognizing morphed emotional facial expressions were assessed using an emotional hexagon task. FINDINGS: Current opiate users were significantly more accurate than ex-users at recognizing expressions of disgust. They were also generally slower than controls in recognizing all expressions, and slower than ex-opiate users in recognizing surprise, happy and fearful expressions. CONCLUSIONS: Opiate users in maintenance treatment show a heightened ability to recognize facial expressions of disgust. We suggest that this may reflect increased exposure to other people's expressions of disgust and/or priming by the physical and social environments encountered by opiate-dependent individuals. Further, opiate maintained individuals' global slowness in processing emotional expressions may reflect the sedative effects of methadone.

An investigation into the sub-acute effects of ecstasy on aggressive interpretative bias and aggressive mood - are there gender differences?

The lowering of serotonin for a period following MDMA use could account for the increases in both self-rated and objective measures of aggression previously found in ecstasy users several days after taking the drug. There is some evidence of gender differences in the acute, sub-acute and long-term effects of MDMA use, and given that gender differences have been found in aggression, it is possible that men may experience more aggression mid-week than women. The aim of this study was to attempt to replicate findings showing increased bias towards aggressive material in ecstasy users several days after using the drug. In addition, to investigate possible gender differences in mid-week aggression. A total of 46 participants were tested: 19 ecstasy users and 27 controls were compared on the night of drug use and 4 days later. On day 4, a task designed to tap cognitive bias toward material with aggressive content was administered. Participants were required to process sentences that could be interpreted as either aggressive or neutral and subsequently remember them in a recognition test. This data set was then combined with the data from Curran et al.'s (2004) study that employed exactly the same procedure. Thus, the data from 107 participants was analysed to investigate gender differences. Ecstasy users recognized more aggressive sentences than controls and tended to react slower to neutral sentences than controls. Ecstasy users also rated themselves as being more aggressive and depressed than controls on day 4. No gender differences were found on any measure of aggression in the combined data set. Both male and female ecstasy users show a bias toward interpretation of ambiguous material in an aggressive manner when compared to controls 4 days after ecstasy use.

The acute and sub-acute effects of 'ecstasy' (MDMA) on processing of facial expressions: preliminary findings.

RATIONALE: There is evidence that serotonergic processes may modulate the processing of fearful facial expressions. It is therefore possible that the recreational drug 'ecstasy' (MDMA), which has marked serotonergic effects, may affect people's ability to recognise human facial expressions portraying fear. OBJECTIVE: The present study therefore aimed to determine whether ecstasy users differed from controls in fear recognition at two time points: shortly after taking the drug and a few days later. METHODS: Sixteen ecstasy users and 21 controls were compared on a facial expression recognition task involving the 6 basic emotions (happiness, surprise, sadness, anger, fear and disgust) and on self-ratings of mood on the night of drug use (day 0) and 4 days later (day 4). RESULTS: In recognising fearful facial expressions, ecstasy users were more accurate than controls on day 0 but less accurate than them on day 4 when compared with their overall ability to recognise other basic emotions. Accuracy of fear recognition on day 4 was negatively correlated with both years of ecstasy use and number of ecstasy tablets taken on a typical session. On self-rated aggression scales, ecstasy users scored lower than controls on day 0 and higher on day 4. CONCLUSIONS: These results support the notion that 5-HT plays a role in modulating the recognition of fearful facial expressions. Increased accuracy of fear recognition may relate to 5-HT release following ecstasy use on day 0, and decreased accuracy may reflect subsequent depletion of 5-HT mid-week.

Empathy and aggression: two faces of ecstasy? A study of interpretative cognitive bias and mood change in ecstasy users.

RATIONALE: As central 5-hydroxytryptamine (5-HT) is attenuated for a period following a single dose of MDMA ("ecstasy") and low 5-HT is associated with aggression, then MDMA users may be more aggressive in the days following an acute dose of the drug. OBJECTIVE: This study therefore aimed to determine if acute use of MDMA is associated with aggression 4 and 7 days later. METHODS: Twenty-nine MDMA users and 32 controls were compared on self-rated aggression and depression on the night of drug use (day 0), 4 and 7 days later. On day 4, participants performed an interpretative bias task in which they processed ambiguous sentences that could be interpreted in either an aggressive or neutral way (e.g. "The painter drew the knife"). RESULTS: MDMA users had faster response times in completing ambiguous aggressive sentences than neutral sentences; controls showed the opposite pattern of performance. In a subsequent recognition task, MDMA users were more confident in judging, and responded faster to, aggressive than neutral sentences; controls again showed the opposite pattern of effects. The level of aggressive interpretative bias positively correlated with extent of MDMA use. Midweek, MDMA users had higher self-rated aggression and depression scores than controls; on day 7, scores of both groups were similar. CONCLUSIONS: MDMA users display a cognitive bias towards interpreting ambiguous information in an aggressive way a few days after taking the drug. Self-rated mid-week low mood and mid-week aggression do not persist 7 days after use of the drug. This pattern of results is consistent both with the acute and residual effects of MDMA on central 5-HT and with the notion that 5-HT plays a role in modulating human aggression.

Contribution of cannabis and MDMA ("ecstasy") to cognitive changes in long-term polydrug users.

RATIONALE: Establishing whether cognitive changes follow long-term use of MDMA ("ecstasy") in humans has been difficult because of possible confounds with other drug use, particularly cannabis. Convincing evidence may be only obtained using experimental designs that account for such confounds. OBJECTIVE: In the present study, cognitive/behavioural measures were used to investigate whether long-term MDMA use or long-term cannabis use is responsible for the changes sometimes observed in recreational MDMA users. METHOD: Tests of attention and memory were administered to subjects who used both MDMA and cannabis, cannabis only, or neither drug. RESULTS: The main finding was that cannabis users, whether or not they also used MDMA, showed significantly impaired memory function on word free-recall and on immediate and delayed story recall compared to non-users. CONCLUSIONS: The findings highlight the importance of controlling for other drug use (particularly cannabis) when investigating persistent effects of MDMA in humans.