背景:患有自闭症谱系障碍(ASD)的个体不仅受到社会交往缺陷和限制性重复行为的定义特征的挑战,而且还有无数的精神病理学的严重程度。不同的认知缺陷支撑着这些精神病理学,可以接受干预以改变疾病的进程。了解特定领域的认知中介作用对于制定有针对性的干预策略至关重要。然而,不同认知功能之间的高度相互关联阻碍了个体效应的阐明。
方法:在费城神经发育队列中,218名ASD患者与872名非ASD对照进行性别匹配,年龄,种族,和社会经济地位。该队列的参与者在神经认知能力和维度精神病理学上进行了深入而广泛的表型分析。使用结构方程模型,在对多领域精神病理学和功能水平的结局进行中介分析之前,调整认知领域之间的相互相关性.
结果:虽然社会认知,复杂的认知,和记忆在ASD的精神病理学领域都有独特的中介效应,对功能水平无显著影响。相比之下,执行功能是唯一对每个精神病理学领域产生普遍负面影响的认知领域(p因子,焦虑-痛苦,精神病,恐惧,和外部化),以及功能层面。
结论:执行功能与ASD合并症精神病理学的严重程度有独特的关联,并可能成为干预的目标。由于执行功能障碍在ASD中发生的变化,我们的结果也支持评估执行功能以达到预后目的的临床实用性.
Individuals with autism spectrum disorder (ASD) are challenged not only by the defining features of social-communication deficits and restricted repetitive behaviors, but also by a myriad of psychopathology varying in severity. Different cognitive deficits underpin these psychopathologies, which could be subjected to intervention to alter the course of the disorder. Understanding domain-specific mediating effects of cognition is essential for developing targeted intervention strategies. However, the high degree of inter-correlation among different cognitive functions hinders elucidation of individual effects.
In the Philadelphia Neurodevelopmental Cohort, 218 individuals with ASD were matched with 872 non-ASD controls on sex, age, race, and socioeconomic status. Participants of this cohort were deeply and broadly phenotyped on neurocognitive abilities and dimensional psychopathology. Using structural equation modeling, inter-correlation among cognitive domains were adjusted before mediation analysis on outcomes of multi-domain psychopathology and functional level.
While social cognition, complex cognition, and memory each had a unique pattern of mediating effect on psychopathology domains in ASD, none had significant effects on the functional level. In contrast, executive function was the only cognitive domain that exerted a generalized negative impact on every psychopathology domain (p factor, anxious-misery, psychosis, fear, and externalizing), as well as functional level.
Executive function has a unique association with the severity of comorbid psychopathology in ASD, and could be a target of interventions. As executive dysfunction occurs variably in ASD, our result also supports the clinical utility of assessing executive function for prognostic purposes.