Anorexia nervosa and autism: a prospective twin cohort study
Anorexia nervosa and autism: a prospective twin cohort study
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DOI：
10.1111/jcpp.13265
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发表时间：
2020-06-04
影响因子：
7.6
通讯作者：
Lundstrom, Sebastian
中科院分区：
文献类型：
--
作者：
Dinkler, Lisa;Taylor, Mark J.;Lundstrom, Sebastian
背景神经性厌食症(AN)和自闭症谱系障碍(ASD)可能是表型和病因相关的。然而，由于缺乏前瞻性研究，目前尚不清楚自闭症特征在儿童早期是否明显升高。在这里，我们前瞻性地调查了第一次诊断ANN之前和之后的自闭症特征。方法在瑞典儿童和青少年双胞胎研究的5987人(52.4%女性)的基于人群的样本中，父母报告了9岁和18岁时的自闭症特征。AN和ASD的诊断从瑞典国家患者登记处检索。此外，通过父母报告的AN治疗确定了诊断。我们比较了在第一次诊断AN之前(9岁)和第一次诊断AN之后(18岁)，患有AN和没有AN的个体在自闭症特征上的差异。结果我们没有发现在后来诊断为AN的9岁儿童中有升高的自闭症特征的证据。然而，在18岁时，限制性/重复行为和兴趣显著增加，但仅在急性AN患者亚组中。结论ASD患者的应对策略和稍有不同的女性ASD表型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的升高。或者，也有可能在AN发病之前并不存在升高的自闭症特征，因此质疑先前报道的AN中ASD患病率的升高。未来的研究应该使用量身定制的测量方法，以调查患有AN的个体的自闭症特征是否最好被概念化为急性AN期的附带现象，或者这些症状是否真的代表ASD是一种临床可验证的神经发育障碍。
Background 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.Methods 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).Results 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.Conclusions 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.