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Linda Angelica Häger,1,2 Geir Øgrim,1,2 Maria Danielsen,1 Eva Billstedt,2 Christopher Gillberg,2 Jakob Åsberg Johnels2,3 1Neuropsychiatric Team, Åsebråten Clinic, Østfold Hospital Trust, Fredrikstad, Norway; 2Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden; 3Speech and Language Pathology Unit, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, SwedenCorrespondence: Linda Angelica HägerNeuropsychiatric Team, Åsebråten Clinic, Østfold Hospital Trust, 1740 Grålum, Fredrikstad PB300, NorwayTel +47 93 28 76 77Email Linda.Hager@so-hf.noObjective: Rating scales and neuropsychological tests including continuous performance tests (CPTs) are widely used to assess executive functions (EFs). Event-related potentials (ERPs) are also used to index certain EFs such as action preparation and inhibition. In this descriptive study, we examined the associations between results on an EF rating scale, a CPT and ERP components in ADHD as a function of age.Methods: Fifty-nine patients with ADHD (and more often than not with comorbid disorders) in two age groups (9– 12 years and 13– 17 years) were assessed using EF ratings, a visual CPT and ERPs (CueP3, P3go and P3no-go).Results: There were age related changes in the ERPs with the CueP3 amplitude being stronger in children, and the P3no-go amplitude stronger in adolescents. The associations between the EF measures were different in the two age groups. In particular, the P3no-go seemed to reflect different EF-related processes in children versus adolescents.Conclusion: Age group effects were seen on a selection of ERP amplitudes in this sample of patients with ADHD. Ratings, test scores and EF-related ERPs seem to capture different aspects of EF in ADHD, and the associations differed depending on age group. The results show that different measures of EF are not interchangeable and highlight the importance of age when interpreting ERPs.Keywords: executive functions, ADHD, electrophysiology, ratings, event related potentials, cognitive control

Diana Cavonius-Rintahaka,1,2 Anna Liisa Aho,3 Arja Voutilainen,2 Eva Billstedt,1 Christopher Gillberg11Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden; 2Child Psychiatry, Neuropsychiatric Unit, Helsinki University Hospital (HUH), Helsinki, Finland; 3Faculty of Social Sciences, Nursing Science, University of Tampere, Tampere, HelsinkiIntroduction: Several studies have reported that having a child with a neurodevelopmental disorder (NDD) increases parental stress and that parental psychosocial functioning influences child`s development and behavior. It is unclear how parents of children with NDD experience family functionality, family health and receive support and if there are differences between experiences of mothers and fathers.Methods: Families with children referred to a neurocognitive unit were invited to the study. A modified version of the FAmily Functionality, HEalth, and Social support (FAFHES) questionnaire was used. Open-ended questions were also included.Results: Parents rated their social support lower than their family functionality and family health. Family functionality correlated positively with family health. No significant differences were found between mothers’ and fathers’ experiences. A three-months test-retest using the FAFHES showed no significant change in ratings of family functionality, family health, and social support.Conclusions: Family functionality was connected to family health in families with a child with NDD. Mothers and fathers experienced their family health, family functionality, and received social support in similar ways.Keywords: parents, family health, family functionality, social support, neurodevelopmental disorders

Hanna Steffenburg, Suzanne Steffenburg, Christopher Gillberg, Eva Billstedt Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Sahlgrenska Academy, Gothenburg, Sweden Background: It has been suggested that autism spectrum disorder (ASD) might be a “comorbid” condition in selective mutism (SM). Methods: In this retrospective study, we examined medical records of children with SM diagnosis (n=97) at a medical center specializing in assessment of ASD. Results: Mean age for onset of SM symptoms was 4.5 years and mean age at SM diagnosis was 8.8 years. SM was more common among girls (boy:girl ratio=2.7:1). We found that 63% of the study group had an ASD (no gender difference). The SM group with combined ASD had later onset of symptoms, higher age at diagnosis, more often a history of speech delay, and a higher proportion of borderline IQ or intellectual disability.Conclusion: The results highlight the risk of overlap between ASD and SM. Keywords: selective mutism, autism spectrum disorders, Asperger syndrome, autistic disorder

Yuhei Hatakenaka,1,2 Hitoshi Ninomiya,3 Eva Billstedt,2 Elisabeth Fernell,2 Christopher Gillberg2 1Kochi Gillberg Neuropsychiatry Centre, Kochi Prefectural Medical and Welfare Center, Kochi, Japan; 2Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; 3Integrated Centre for Advanced Medical Technologies, Kochi University Medical School, Kochi, Japan Background: Screening for developmental disorders is an important task for Child Health Care. The concept of ESSENCE (early symptomatic syndromes eliciting neurodevelopmental clinical examinations) was created to cover all types of early developmental disorders and the ESSENCE-Questionnaire (ESSENCE-Q containing 12 questions with possible total scores ranging from 0 to 22) was developed as a tool for early detection of these disorders. The aim of this study was to perform a validation study in a public health situation in Japan.Methods: The psychometric properties of the ESSENCE-Q, completed by mothers, public health nurses (PHNs), and psychologists at 18-month (n=143 children) and 36-month (n=149 children) checkups were evaluated in a small city of Japan. Results were validated against clinical ESSENCE diagnoses. Receiver operating characteristic curves were generated and compared by using the area under the curve (AUC). Optimal cutoff values were explored.Results: At the 18-month checkup, AUC by mothers was 0.72, by PHNs 0.86, and by psychologists 0.82. An optimal cutoff was 3 with a high negative predictive value (NPV). At the 36-month checkup, AUC by mothers was 0.57, by PHNs 0.82, and by psychologists 0.87. Optimal cutoff was 2 with high NPV.Conclusion: The ESSENCE-Q completed by PHNs and psychologists had good diagnostic validity. The results suggested that almost all children scoring under cutoff would not have any ESSENCE problems/diagnoses. Keywords: ESSENCE, questionnaire, public health nurse, receiver operating characteristic, ROC, area under the curve, AUC, optimal cutoff, negative predictive value, NPV

Objective In order to study secular changes in personality factors neuroticism and extroversion, representative population samples of non-demented 75-year-olds underwent psychiatric examinations in 1976-1977 (total n = 223, 138 women, 85 men) and 2005-2006 (total n = 556, 322 women and 234 men). Methods Eysenck Personality Inventory was used at both occasions. Demographic factors (educational level, marital status, having children) were registered. Results Seventy-five-year-olds examined in 2005-2006 had higher values on extroversion and lower values on the Lie scale compared with those examined in 1976-1977. Neuroticism did not differ between the two birth cohorts. Neuroticism scores were higher in women than in men both in 1976-1977 and 2005-2006, and Lie score was higher in women than in men in 2005-2006. Conclusions Our findings suggest that present cohorts of 75-year-olds are more extroverted and less prone to respond in a socially desirable manner than those born three decades earlier. Neuroticism levels remained unchanged, suggesting this trait may be less influenced by environmental factors than the other traits studied. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The rate of autism spectrum disorders (ASDs) and brain abnormalities was analyzed in 31 individuals (15 males, 16 females; age range 1mo to 31y, mean age 8y 11mo) with CHARGE association, as part of a multidisciplinary study. A meticulous neuropsychiatric examination was performed, including standardized autism diagnostic interviews. Judgement regarding ASDs was impossible in three infants and three patients who were deaf and blind. Five individuals met diagnostic criteria for autism, five for an autistic-like condition, and seven for autistic traits. Brain abnormalities were indicated in almost three-quarters of examined individuals, and midline abnormalities of the forebrain in one-third. Awareness of the coexistence of CHARGE and ASDs is important in habilitation care in CHARGE. Moreover, the results indicate that a subgroup of ASDs may be associated with errors in early embryonic brain development. [ABSTRACT FROM AUTHOR]

Introduction Co-existing problems are a rule rather than exception in child psychiatry, although rarely studied. Clinical experiences suggest that anxiety and depression are common co-existing problems in children with neurodevelopmental disorders, affecting communication, social adjustment and cognition. Research also implies that the correlation between self-reports and other sources of information is relatively low. In clinical practice, it is frequently presumed that only one source of information is correct, usually from the parents. Objectives The objectives of the study are to view the self-reported mental health in a group of children with ADHD and/or ASD and its connection to global functioning. A second objective is to study the compliance between reports of mental health from the parents and from the child. Aims The aim of the study is to examine the connection between mental health and function in a group of children with ADHD and/or ASD. Methods The study includes 65 children (mean age = 16) with ADHD ( n = 24), ASD ( n = 24) or ADHD/ASD ( n = 17). Instruments used are the self-report Beck Youth Inventories Scale and the parent report Five to Fifteen questionnaire. The measure for adaptive functioning was the Global Assessment of Functioning scale. Results The study is currently in its final stage and we will present the results during the conference. We will report prevalence of symptoms of anxiety and depression and its correlation to global functioning, as well as the compliance between parent and self-reports. Conclusions The study emphasizes the importance of assessing psychiatric conditions in children with neurodevelopmental disorders. [ABSTRACT FROM AUTHOR]

Aim: To study the diagnostic stability of developmental language disorders, other neurodevelopmental disorders and interventions received until age 6 years in children who screened positive for language delay, but not for autism, at age 2.5 years., Methods: In 2016, in Gothenburg, Sweden, 100 monolingual or multilingual children underwent language assessment at a mean age of 2.9 years. At age 6 years, 85 of these children underwent language assessment. A review of paediatric records was performed after the clinical assessment to obtain information about other neurodevelopmental disorders and interventions received., Results: At age 6 years, 74/85 (87%) of the children had persistent language disorders, and 20/85 (24%) had been diagnosed with at least one additional neurodevelopmental disorder. Five of them had autism. In general, families only attended half of the offered intervention sessions irrespective of intervention type and no difference between monolingual and multilingual families was found., Conclusions: The persistence of language disorder and the presence of later additional neurodevelopmental disorders highlight the importance of longitudinal and multidisciplinary monitoring of children with delayed language development. Further studies and analyses are warranted to investigate the reasons behind the poor attendance rate for interventions offered., (© 2024 The Author(s). Acta Paediatrica published by John Wiley & Sons Ltd on behalf of Foundation Acta Paediatrica.)

Competing Interests: We declare no competing interests.

The Working Memory Index (WMI) in the Wechsler Intelligence Scale for Children (WISC) has been suggested to be associated with ADHD symptoms. The relationship between WMI and ADHD symptoms in the general population is not clear. The study aimed to examine the association between working memory (WM) and behavioral regulation (BR), and hyperactivity/inattention (HI) in a general population sample of 7-8-year-olds, and whether general intellectual functioning is associated with BR and HI. The study also examined if those with low WMI also fulfill elevated ADHD criteria. The study group ( N  = 865) was assessed with the WISC (Fourth edition), the Behavior Rating Inventory of Executive Function, the Strengths and Difficulties Questionnaire, and the Five to Fifteen Questionnaire, and divided into three groups based on WM function, and in relation to BR and/or HI problems. The associations between WM and BR, and WM and HI, including intellectual functioning as covariate, were examined. WM deficits were found in 22%, but the majority of those had no BR or HI problems. Four percent in the study group had WM deficits combined with BR and/or HI problems, and in about one third of those inattentive ADHD criteria were fulfilled. WM and prosocial behavior were associated with BR and HI. WM deficits measured with WISC WMI in 7-8-year-olds do not always signal BR and/or HI problems.

Aim: Deviant visual processing has been observed in autism spectrum disorder (ASD), manifesting as decreased P1 and P2 components of visual event-related potentials (ERPs). Alterations have been attributed to a failure of Bayesian inference, characterized by hypo-activation of top-down predictive abilities. To test this hypothesis, we measured the visual negativity (vN) as an ERP index of visual preparation hypothesized to mirror predictive brain activity. Method: ERPs in a cued visual GO/NOGO task in 63 adolescents with ASD (IQ > 70, attention-deficit hyperactivity disorder excluded) were compared with ERPs in a sex- and age-matched group of 60 typically developing (TD) controls. Results: The behavioral variables (omissions, commissions, reaction time, and reaction time variability), as well as ERP components reflecting, among other processes, cognitive control (contingent negative variation, P3 GO, P3 NOGO, N2 NOGO) did not differ between the groups. There were group differences in visually based ERPs. Besides P1 and P2 differences, the vN component differentiated the 2 groups with the highest effect size ( d   =  0.74). Conclusion: This ERP study lends support to the hypothesis suggesting that a Bayesian hypo-prediction could underlie unique perceptual experiences in individuals with ASD. This could lead to a predisposition to perceive the world with reduced influence and modulation from contextual cues, prior experiences, and pre-existing expectations., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: We declare no competing interests.

Purpose: Autism Spectrum Disorder (ASD) occurs in 1-1.5% of the general population and possibly in up to 20% of psychiatric outpatients. Post Traumatic Stress Disorder (PTSD) occurs at some point in life in 4% of the general population and in 14-20% of psychiatric outpatients. Knowledge about how PTSD manifests in people with ASD is important in order for it to be correctly diagnosed and intervened for., Methods: This study investigated the relationship between PTSD and autism among adult psychiatric outpatients (N = 90) of whom 63 had ASD or subthreshold ASD based on DSM-5 criteria. The study group was subjected to in-depth psychiatric assessments using validated instruments. Diagnosis of PTSD was made based on the Mini International Neuropsychiatric Interview (MINI)., Results: There was a trend towards PTSD being more common among participants with ASD compared to participants without ASD, although significant differences could not be shown in this small sample. 21% of the ASD group had current PTSD, compared to 4% of the study group without ASD. There were no differences between the groups regarding exposure to trauma. There was a trend towards a relationship between number of autism symptoms and hyperarousal symptoms in PTSD. Conversely, the PTSD symptom of irritability/outbursts of anger, was significantly associated with number of autism symptoms., Conclusions: A subgroup of psychiatric outpatients with ASD also suffer from PTSD. Hyperarousal symptoms are possibly more prevalent in the presentation of PTSD in individuals/patients with ASD compared to those without ASD., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Intelligence tests predict academic achievement in typically developed children, however if this is the case also in children with attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) is not clear. This systematic review and meta-analysis examined if Wechsler intelligence scales predict academic achievement and/or grades in children, ages 6-16 years, with ADHD and/or ASD. We searched the databases PubMed, PsycINFO and Education Research Complete for studies published between 2000 and 2023. We used the Newcastle-Ottawa Scale to assess risk of bias. Narrative synthesis and meta-analysis were performed. Twelve studies (ADHD n = 1,834, ASD n = 176) were included in the review, and six samples (ADHD n = 1,112) of those were included in the meta-analyses. The results of the meta-analyses showed moderate overall weighted correlations between IQ and word reading, written language, and mathematics respectively. Similarly, the overall weighted correlations between processing speed and the aforementioned domains of academic achievement were moderate. Meta-analysis with additional Wechsler scales composite scores could not be conducted. In the narrative synthesis, Full Scale IQ was associated with academic achievement in both ADHD and ASD, and grades in ADHD. The limited number of ASD participants and the heterogeneity of the samples need to be considered when interpreting results. Generally, the results indicate that Wechsler scales are valuable in predicting academic achievement in children with ADHD or ASD. Motivation and other factors related with academic achievement need to be further explored in these groups.

This study investigated language ability in 6-year-old mono- and multilingual children who, at age 2;6 years, had screened positive for developmental language disorder (DLD). One hundred children (32 girls, 68 boys) were assessed at an average age of 2;9 years (T1) and 85 of them (30 girls, 55 boys) were reassessed at age 6;0 years (T2) using a standardised test battery. Of these, 68 (23 girls, 45 boys) met the criteria for DLD diagnosis; 28 of them were monolingual and 40 multilingual. Language profiles at T2 were analysed, as were the associations between DLD and a mono- or multilingual background as well as other measures collected at T1, including mean length of utterance (MLU), heredity and parental education. As expected, the results showed that the total group (including both mono- and multilingual children) scored below test norms for 6-year-olds on all language tests, except for receptive vocabulary, where the monolingual children scored in line with those norms. The multilingual group performed significantly less well than the monolingual one on language comprehension, receptive vocabulary, recalling sentences, word finding and story retelling; disparities regarding MLU and language comprehension were already evident at T1. Interestingly, MLU at T1 showed a moderate association with language comprehension at T2 in the total group. The monolingual children were more likely than the multilinguals to have heredity for DLD or reading and writing disorders. In conclusion, language difficulties identified through screening and assessment before age 3 years often persist at age 6 years.

Background: The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services., Aims: We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group., Method: Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full ( n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made., Results: In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women., Conclusions: Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

Introduction: 22q11.2 deletion syndrome (22qDS) has been associated with varying levels of social impairments, and with atypical visual scanning of faces. The present study explored whether self-reported sensitivity to eye contact might be related to these phenomena., Method: Individuals with confirmed 22qDS were interviewed about their experience and possible discomfort with eye contact. In cases where individuals expresesed discomfort, they were subsequently asked about coping mechanisms used to deal with this discomfort. In addition to self-reported eye contact discomfort, gaze to emotional faces was examined using eye tracking., Results: In the subgroup of individuals who reported discomfort during eye contact, eye tracking results revealed a lower amount of gaze in the eyes of neutral faces, as well as the absence of the typical left visual field (LVF) bias, indicative of alterations in hemispheric lateralization. This subgroup also scored lower on a measure of everyday functioning., Conclusions: Our results show that, by simply asking individuals with this social and communicative disorder about eye gaze discomfort, we may better understand the specific challenges that they experience. Moreover, information gained from such first-person reports together with eye-tracking measures further informs about the integrity of their face processing system, as well as about the nature and degree of impairment in this population.

Autistic traits are continuously distributed in the general population. The associations between autistic traits and intellectual functioning and/or behavioural difficulties, and the impact of intellectual functioning on behavioural difficulties are unclear. The study aims to describe the distribution of autistic traits in a population-based cross-sectional sample of children. Further aims are to examine the association between intellectual functioning and autistic traits, and between autistic traits and behavioural difficulties. Wechsler scales and ratings of autistic traits and behavioural problems in 874 children aged 7-9 years in the Swedish Environmental Longitudinal Mother and Child, Asthma and Allergy (SELMA) study were assessed. We found a continuous distribution of autistic traits. Intellectual functioning was negatively associated with autistic traits but not with behavioural difficulties. Behavioural difficulties were associated with autistic traits., (© 2023. The Author(s).)

The 22q11.2 deletion syndrome (22q11.2DS), affects physical as well as cognitive and emotional functioning with increased risk for psychiatric and behavioral problems. This longitudinal study of 79 individuals (18-50 years) with 22q11.2DS investigated neurodevelopmental (NDD) and psychiatric disorders in adulthood, evaluated the stability of childhood diagnoses over time, and examined associations between clinical characteristics in childhood/adolescence and diagnostic outcome in adult age. Examination using validated instruments for cognitive, psychiatric, and global functional problems in the context of an in-depth clinical evaluation found adult age stability of NDD diagnoses made in childhood, however, rates increased at follow-up. Rates of anxiety, mood, and psychotic disorders were high, with a majority meeting diagnostic criteria for one or more psychiatric disorder. The rate of psychotic disorders was much lower compared to many other studies. Variability in functioning at follow-up was primarily associated with intellectual ability at T1. The findings obtained highlight the increased risk of NDD and psychiatric problems and of cognitive impairment and reduced levels of global functioning over time. Results emphasize the importance of clinical follow-up to enable appropriate support for the promotion of optimal health along with a need for future research on effective interventions and treatment strategies., (© 2023 The Authors. American Journal of Medical Genetics Part C: Seminars in Medical Genetics published by Wiley Periodicals LLC.)

Background: Patients with 'underlying' autism spectrum disorder (ASD) constitute a significant minority in adult out-patient psychiatry. Diagnoses of previously unrecognised ASD are increasing in adults. Characteristics of patients with autism within adult out-patient psychiatry have not been sufficiently explored, and there have not been any systematic comparisons of characteristics between patients with and those without autism within adult out-patient psychiatric populations., Aims: To examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients., Method: We assessed 90 patients who were referred to a Swedish psychiatric out-patient clinic and screened for ASD during 2019-2020. Sixty-three patients met the DSM-5 criteria for ASD or 'subthreshold' ASD. The 27 who did not meet the criteria for ASD were used as a comparison group. Assessments were made with structured and well-validated instruments, including parent ratings of developmental history., Results: No differences were found between the groups regarding self-reported sociodemographic variables. The ASD group showed a higher number of co-occurring psychiatric disorders than the non-ASD group ( t (88) = 5.17, 95% CI 1.29-2.91, d = 1.19). Functional level was lower in the ASD group ( t (88) = -2.66, 95% CI -9.46 to -1.27, d = -0.73), and was predicted by the number of co-occurring psychiatric disorders., Conclusions: The results underscore the need for thorough assessment of psychiatric disorders in autistic patients in adult psychiatric services. ASD should be considered as a possible 'underlying' condition in adult psychiatry, and there is no easy way of ruling out ASD in this population.

Purpose: Although persistent offenders with histories of imprisonment and violence have disproportionate high rates of psychiatric disorders, little is known of their psychiatric healthcare utilization (HCU) and HCU-associated factors. This study aimed to explore psychiatric HCU, psychiatric morbidity, and psychotropic prescription drugs in violent offenders with a history of incarceration., Methods: Male offenders aged 18-25 (n = 266) imprisoned for violent and/or physical sexual offenses were clinically assessed in 2010-2012 and prospectively followed in Swedish national registries through 2017. Register-based information regarding HCU, psychiatric morbidity, and psychotropic drugs was tracked and compared with a general population group (n = 10,000) and across offending trajectory groups. Baseline risk factors were used to explain prospective psychiatric HCU in violent offenders., Results: Violent offenders used less general healthcare and psychiatric outpatient care, but more psychiatric inpatient care and were more often given psychiatric diagnoses and psychotropic drugs than the general population. Participants previously assigned to persisting offending trajectory groups had higher rates of psychiatric HCU than those assigned to a desisting trajectory. In multivariable regression models, psychiatric HCU was associated with anxiety disorders, prior psychiatric contact, placement in a foster home, psychopathic traits, low intellectual functioning, and persistent offending., Conclusions: Violent offenders are burdened by extensive and serious psychiatric morbidity and typically interact with psychiatric healthcare as inpatients rather than outpatients. Knowledge about their backgrounds, criminal behaviors, and psychiatric statuses can aid the planning of psychiatric services for this troublesome group., (© 2022. The Author(s).)

Relatively little has been published about the prevalence of autism in adults with psychiatric disorders. In this study, all new patients referred to an adult psychiatric outpatient clinic in Sweden between November 2019 and October 2020 (n = 562) were screened for autism spectrum disorders using the Ritvo Autism and Asperger Diagnostic Scale Screen (RAADS-14). Out of the 304 (58%) responders, 197 who scored above the cut off (14) were invited to participate in an in-depth assessment. Twenty-six of the 48 that participated in the assessment met criteria for ASD and an additional eight had subthreshold ASD symptoms. We estimated the prevalence of ASD in this population to at least 18.9%, with another 5-10% having subthreshold symptoms., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

"Missed" cases with neurodevelopmental disorders (NDDs) within adult psychiatry services have attracted increasing attention in the last decade. Key questions have been what the prevalence of NDDs (particularly attention-deficit/hyperactivity disorder/ADHD and autism spectrum disorder/ASD) is, and what the clinical and gender characteristics of those with NDD in adult psychiatry are. All first-time attenders at an adult psychiatry clinic serving 18-25 years old were invited to take part in the study regardless of cause of concern. Participation in the study included diagnostic in-depth evaluation performed by experienced adult psychiatrists. Clinical diagnoses (DSM-IV-TR and DSM-5 criteria) were based on all available information (clinical psychiatric interview, clinical observation, and self-rating questionnaires). Almost two thirds (63%) of the study group met criteria for ADHD or ASD. Most of the patients with NDD (particularly the "NDD females") had not been diagnosed in childhood. Twelve percent of the females included had been given an ADHD diagnosis in childhood. In the current study we found that 48% of the females had ADHD. The high male:female NDD ratio reported among children, was not obvious in our NDD group. The results underscore the importance of screening for NDD in adult psychiatric services regardless of referral reason., (Copyright © 2022. Published by Elsevier B.V.)

ADHD in adults is commonly associated with severe impairments in many major life activities, and an adequate diagnosis is a first step towards treatment and support. Negative consequences follow both underdiagnosis and overdiagnosis of adult ADHD, which can be confused with other psychiatric diagnoses and sometimes overlooked in people with high intellectual capacity, and in women in general. In a clinical practice, most physicians meet adults with ADHD - with or without a diagnosis - and therefore need competence in screening of ADHD in adults. Experienced clinicians conduct the consequent diagnostic assessment, to reduce risk of both underdiagnosis and overdiagnosis. Several national and international clinical guidelines summarize evidence-based practices for adults with ADHD. European Network Adult ADHD, ENAA, revised consensus statement recommends pharmacological treatment and psychoeducation as a first step after ADHD diagnosis in adulthood.

Gaze patterns during face perception have been shown to relate to psychiatric symptoms. Standard analysis of gaze behavior includes calculating fixations within arbitrarily predetermined areas of interest. In contrast to this approach, we present an objective, data-driven method for the analysis of gaze patterns and their relation to diagnostic test scores. This method was applied to data acquired in an adult sample (N = 111) of psychiatry outpatients while they freely looked at images of human faces. Dimensional symptom scores of autism, attention deficit, and depression were collected. A linear regression model based on Principal Component Analysis coefficients computed for each participant was used to model symptom scores. We found that specific components of gaze patterns predicted autistic traits as well as depression symptoms. Gaze patterns shifted away from the eyes with increasing autism traits, a well-known effect. Additionally, the model revealed a lateralization component, with a reduction of the left visual field bias increasing with both autistic traits and depression symptoms independently. Taken together, our model provides a data-driven alternative for gaze data analysis, which can be applied to dimensionally-, rather than categorically-defined clinical subgroups within a variety of contexts. Methodological and clinical contribution of this approach are discussed., Competing Interests: Declaration of competing interest David Eberhard, Martyna Galazka, Jakob Åsberg Johnels, Christopher Gillberg, Eva Billstedt, Nouchine Hadjikhani, and Tobias S. Andersen declare that they have no conflict of interests. Paolo Masulli is employed by iMotions A/S., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Long-term effects of ADHD medication on cognitive functions are not well known. This study investigates development of cognitive functions and ADHD symptoms on well-controlled medication for 1 year in children and adolescents., Study Design: This study is part of an ongoing open uncontrolled trial of long-term medication for ADHD in children and adolescents aged 6-18 years with any form of ADHD, and frequently comorbid autism spectrum disorder (ASD, 29%) or autistic traits (24%). Other comorbidities were oppositional defiant disorder, dyslexia/language disorder, borderline intellectual functioning, developmental coordination disorder. This analysis includes 87 participants (61 boys, 26 girls) who completed Wechsler tests at baseline and after 12 months. ADHD symptoms were investigator-rated on the ADHD Rating Scale-IV at the same time points., Results: The whole group of children and adolescents showed significant improvements in Wechsler Full Scale IQ (FSIQ, mean at baseline 92.6, at 12 months 97.95), and on the Index Scales Verbal Comprehension, Working Memory and Processing Speed, after one year of well-controlled ADHD medication. Comorbid dyslexia/language impairment predicted a larger rise in FSIQ, but not gender, ADHD presentation or comorbid ASD. Robust improvements in ADHD symptoms were observed (mean ADHD-Rating Scale score at baseline 34.6, and at 12 months 18.3)., Conclusions: Cognitive test scores and ADHD symptoms were improved on well-controlled medication for 1 year in children and adolescents with ADHD, autism and other comorbidities. The main study limitation is the open uncontrolled trial design., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Previous studies have shown an association between IQ and adaptive global functioning, i.e. how well a person is functioning in different domains of life. However, it is unclear to what extent such an association applies in children with neurodevelopmental disorders (NDDs). The study group consisted of 550 population-screened children assessed with the K-SADS, WISC-IV, and the C-GAS. Approximately half of the sample had been diagnosed with one or several NDDs (ADHD, autism, language disorder and tic disorder). A factorial ANOVA with IQ level and the presence of NDD was conducted, with C-GAS score as the dependent variable. Results revealed a significant interaction effect between IQ-group and NDD-status. In the non-NDD group (49% girls), higher IQ scores were clearly linked with better global adaptive functioning. Among children with NDDs (35% girls), however, higher IQ scores were not clearly associated with better functioning. Thus, the association between IQ and adaptive functioning were found to differ depending on the presence of NDD. These results have implications for the interpretation of IQ test results in neurodevelopmental assessments and point towards the importance of providing support based on an assessment of needs and functioning rather than scores from IQ tests., (Copyright © 2021. Published by Elsevier B.V.)