Clinical research updates

Abstract

Rebecca Kingston

South London and Maudsley NHS Foundation Trust

The term ‘quasi-autism’ (QA) describes the autism-like difficulties that are observed in a high number of children who had prolonged negative social experiences in early childhood. QA is one of several challenges that can arise as a result of early deprivation. These challenges are referred to as deprivation-specific problems (DSP) and include QA, attention deficit and hyperactivity disorder (ADHD), disinhibited social engagement disorder (DSE) and cognitive impairment. Furthermore, all the DSPs continue to be seen throughout adolescence and early adulthood even when children are removed from deprivation in early childhood.

In this recent study, Rodriguez-Perez et al. (2023) investigated the persistence of QA and other DSPs in adulthood, and the impact of QA on well-being, daily functioning and relationships. A total of 217 adoptees were compared into three groups: those who experienced early deprivation and were identified as having QA in childhood, adoptees who had experienced early deprivation but did not present with childhood QA and adoptees who had no experience of deprivation (Low/No deprivation). A wide range of measures were collected throughout childhood and into early adulthood looking at the presence of DSP symptoms and the outcomes of the adoptees. As it had been demonstrated in previous research, the study finds that symptoms of QA, ADHD and DSE continue to be seen throughout childhood and into young adulthood. IQ also remains significantly lower in adoptees who had experienced early deprivation when compared to those who had not.

Looking specifically at symptoms of QA, the study shows that while the levels of social reciprocal interaction remain the same into early adulthood and repetitive and stereotyped behaviours are marginally better, communication difficulties worsen. This differs from what is typically seen in idiopathic autism where improvements have been identified across all symptom clusters. A further point of note is that, while not as prominent as they are in adoptees with childhood QA, elevated levels of QA symptoms are seen in the adoptees who have experienced childhood deprivation but do not present with QA. Although they may not meet the clinical threshold for QA, people who have experienced deprivation are more likely to experience some of the same difficulties. Regarding the impact of QA on mental health, functioning and relationships, this study demonstrates that QA is linked to higher prevalence of mental health difficulties and use of services as well as negative impact on daily functioning such as education, employment and independent living. However, while those with QA are seen to have less success with romantic relationships, familial relationships are not negatively impacted. Furthermore, the adoptees with childhood QA have comparable levels of self-esteem and life satisfaction to the other groups, in contrast to the negative self-esteem outcomes often seen in idiopathic autism.

This is the first longitudinal study to look at the impact of QA on a wide range of adult outcomes across multiple aspects of functioning. A limitation of the study is that, while the gender ratio was similar across the two groups who had experienced childhood deprivation, there were fewer girls in the low/no deprivation group. Given the well-established gender differences seen in idiopathic autism, this would be worth accounting for in further research looking at QA.

Rodriguez-Perez, M., Kennedy, M., Barker, E.D., Kreppner, J., Solerdelcoll, M., & Sonuga-Barke, E.J.S. (2023). The adult outcome of childhood quasi-autism arising following extreme institutional deprivation. Journal of Child Psychology and Psychiatry, 64, 1292–1302.

Konstantinos Stathias

National and Kapodistrian University of Athens

Mood disorders are among the most common mental health problems encountered in adults, with a high prevalence in the general population. They are also associated with a variety of mental health adverse outcomes in their offspring, with anxiety disorders being the most frequently associated conditions. In turn, anxiety disorders in childhood lead to an increased risk of mood disorders in adulthood, raising the possibility of a recurring transgenerational vicious cycle.

Tu, Manley, Saunders, and Creswell (2023) conducted a systematic review and meta-analysis with the aim to investigate the association between mood disorders, namely unipolar and bipolar depression, and anxiety disorders in the patients' offspring and explore any other possible factors that might lead to the development of psychopathology in the offspring of such parents. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and identified original studies, reporting on offspring of parents with mood disorders compared to those without such diagnoses, and anxiety disorders in the offspring. They included 35 cross-sectional and cohort studies in the final analysis, which identified an increased lifetime rate for all types of anxiety disorders in the offspring of parents with mood disorders compared to those of control parents, except for agoraphobia. Specifically, the meta-analysis presented an increased risk for overall anxiety disorders (RR = 1.82, 95% CI = 1.47–2.26), with the risk of panic disorder being especially elevated (RR = 3.07, 95% CI = 2.19–4.32).

Based on the above results, offspring of parents with mood disorders are approximately twice as likely to have an anxiety disorder compared to offspring whose parents do not have a mood disorder. This represents a prevalence of 1 in 8 children of parents with a mood disorder having some form of anxiety disorder, compared to 1 in 15 children in the general population. Subgroup analysis revealed no difference in offspring anxiety disorder between parents with bipolar disorder versus unipolar depression. Furthermore, the study underlined the significant role of sex-specific transmission of parental mood disorder to certain offspring anxiety disorders and the mitigating effect of older offspring age.

Limitations of this systematic review and meta-analysis include a focus on White populations and high-income Western countries, the inability to establish the direction of causality, compromised reliability of symptom recall due to the use of cross-sectional studies, inadequate individual-level data on additional risk factors such as offspring age, a focus on childhood diagnosis of anxiety disorders and finally the inclusion of five studies that relied on parent-reported only diagnostic interviews.

Tu, E.N., Manley, H., Saunders, K.E.A., & Creswell, C. (2023). Systematic review and meta-analysis: Risks of anxiety disorders in offspring of parents with mood disorders. Journal of the American Academy of Child & Adolescent Psychiatry. https://doi.org/10.1016/j.jaac.2023.06.022

No ethical approval was required for these updates.