Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-25T09:13:57.275Z Has data issue: false hasContentIssue false
  • English
  • Français

The broad autism phenotype in real-life: clinical and functional correlates of autism spectrum symptoms and rumination among parents of patients with autism spectrum disorder

Published online by Cambridge University Press:  21 November 2019

Barbara Carpita Open the ORCID record for Barbara Carpita [Opens in a new window] ,
Claudia Carmassi ,
Sara Calderoni ,
Dario Muti ,
Alessia Muscarella ,
Gabriele Massimetti ,
Ivan M. Cremone ,
Camilla Gesi ,
Eugenia Conti  and
Filippo Muratori
...Show all authors
Barbara Carpita*
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Claudia Carmassi
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Sara Calderoni
Affiliation:
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, University of Pisa, Pisa, Italy
Dario Muti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Alessia Muscarella
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Gabriele Massimetti
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Ivan M. Cremone
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Camilla Gesi
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
Eugenia Conti
Affiliation:
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, University of Pisa, Pisa, Italy
Filippo Muratori
Affiliation:
Department of Developmental Neuroscience, IRCCS Fondazione Stella Maris, University of Pisa, Pisa, Italy
Liliana Dell’Osso
Affiliation:
Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
*
*Barbara Carpita, MD, Department of Clinical and Experimental Medicine Section of Psychiatry, University of Pisa, Pisa, Italy. Email: barbara.carpita1986@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Increasing literature reported higher rates of psychiatric disorders in parents of children with autism spectrum disorder (ASD), as well as of autistic-like features in social and cognitive functioning. However, little attention has been paid to the association between autistic traits (AT) and global functioning in this population. The aim of the present work was to investigate clinical and functional correlates of AT among parents of ASD children, with a specific focus on ruminative thinking.

Methods

One hundred and twenty parents of ASD children were assessed by the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the Adult Autism Subthreshold Spectrum (AdAS Spectrum), the Ruminative Response Scale (RRS), the Social and Occupational Functioning Assessment Scale (SOFAS).

Results

Subjects with at least 1 psychiatric disorder (39.2%) showed significantly higher AdAS Spectrum and RRS scores. Subjects with a history of school difficulties and with language development alterations scored significantly higher on specific AdAS Spectrum domains. A significant negative correlation was found between SOFAS and AdAS Spectrum scores, as well as between SOFAS and RRS scores. AdAS Spectrum nonverbal communication domain score was identified has a statistically predictive variable for the presence of psychiatric disorders and lower SOFAS scores. Finally, we found a significant indirect effect of AdAS total score on SOFAS score, which was fully mediated by RRS total score.

Conclusions

AT in parents of ASD children seem to be associated with a higher vulnerability toward psychopathology and with a lower global functioning. Ruminative thinking may play a role in the relationship between AT and functional outcome.

Keywords

Broad autism phenotyperuminative thinkingsubthreshold autism spectrumglobal functioningparents
Type
Original Research
Information
CNS Spectrums , Volume 25 , Issue 6 , December 2020 , pp. 765 - 773
Copyright
© Cambridge University Press 2019

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychiatric Association (APA). Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.Google Scholar
Carpita, B, Muti, D, Dell’Osso, L. Oxidative stress, maternal diabetes, and autism spectrum disorders. Oxid Med Cell Longev. 2018;2018:3717215.CrossRefGoogle ScholarPubMed
Bai, D, Yip, BHK, Windham, GC, et al. Association of genetic and environmental factors with autism in A5-country cohort. JAMA Psychiatry. 2019 (Epub ahead of print). doi:10.1001/jamapsychiatry.2019.1411.CrossRefGoogle ScholarPubMed
Carpita, B, Marazziti, D, Palego, L, et al. Microbiota, immune system and autism spectrum disorders. an integrative model towards novel treatment. Curr Med Chem. 2019 (Epub ahead of print). doi:10.2174/0929867326666190328151539.Google Scholar
Kim, JY, Son, MJ, Son, CY, et al. Environmental risk factors and biomarkers for autism spectrum disorder: an umbrella review of the evidence. Lancet Psychiatry. 2019;6(7):590–600.CrossRefGoogle Scholar
Folstein, S, Rutter, M. Infantile autism: a genetic study of 21 twin pairs. J Child Psychol Psychiatry. 1977;18(4):297–321.CrossRefGoogle ScholarPubMed
Piven, J, Gayle, J, Chase, GA, et al. A family history study of neuropsychiatric disorders in the adult siblings of autistic. J Am Acad Child Adolesc Psychiatry. 1990;29(2):177–183.Google ScholarPubMed
Bolton, PF, Macdonald, H, Pickles, A, et al. A case–control family history study of autism. J Child Psychol Psychiatry. 1994;35(5):877–900.CrossRefGoogle ScholarPubMed
Le Couteur, A, Bailey, A, Goode, S, et al. A broader phenotype of autism: the clinical spectrum in twins. J Child Psychol Psychiatry. 1996;37(7):785–801.CrossRefGoogle ScholarPubMed
Piven, J, Palmer, P, Landa, R, et al. Personality and language characteristics in parents from multiple incidence autism families. Am J Med Genet. 1997;74(4):398–411.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Murphy, M, Bolton, P, Pickles, A, et al. Personality traits of the relatives of autistic probands. Psychol Med. 2000;30(6):1411–1424.CrossRefGoogle ScholarPubMed
Pickles, A, Starr, E, Kazak, S, et al. Variable expression of the autism broader phenotype: findings from extended pedigrees. J Child Psychol Psychiatry. 2000;41(4):491–502.CrossRefGoogle ScholarPubMed
Szatmari, P, MacLean, JE, Jones, MB, et al. The familial aggregation of the lesser variant in biological and nonbiological relatives of PDD probands: a family history study. J Child Psychol Psychiatry. 2000;41(5):579–586.CrossRefGoogle ScholarPubMed
Losh, M, Childress, D. Defining key features of the broad autism phenotype: a comparison across parents of multiple- and single-incidence autism families. Am J Medical Genet B Neuropsychiatr Genet. 2008;147B(4):424–433.CrossRefGoogle ScholarPubMed
Billeci, L, Calderoni, S, Conti, E, et al. The broad autism (endo)phenotype: neurostructural and neurofunctional correlates in parents of individuals with autism spectrum disorders. Front Neurosci. 2016;10:346.CrossRefGoogle ScholarPubMed
Piven, J, Palmer, P, Jacobi, D, et al. Broader autism phenotype: evidence from a family history study of multiple-incidence autism families. Am J Psychiatry. 2008;154(2):185–190.Google Scholar
Sucksmith, E, Allison, C, Baron-Cohen, S, et al. Empathy and emotion recognition in people with autism, first-degree relatives, and controls. Neuropsychologia. 2013;51(1):98–105.Google ScholarPubMed
Bishop, DV, Maybery, M, Maley, A, et al. Using self-report to identify the broad phenotype in parents of children with autistic spectrum disorders: a study using the autism-spectrum quotient. J Child Psychol Psychiatry. 2004;45(8):1431–1436.Google ScholarPubMed
Whitehouse, AJ, Barry, JG, Bishop, DV. The broader language phenotype of autism: a comparison with specific language impairment. J Child Psychol Psychiatry. 2007;48(8):822–830.CrossRefGoogle ScholarPubMed
Wheelwright, S, Auyeung, B, Allison, C, et al. Defining the broader, medium and narrow autism phenotype among parents using the Autism Spectrum Quotient (AQ). Mol Autism. 2010;1(1):10.CrossRefGoogle Scholar
Sucksmith, E, Roth, I, Hoekstra, RA. Autistic traits below the clinical threshold: re-examining the broader autism phenotype in the 21st century. Neuropsychol Rev. 2011;21(4):360–389.CrossRefGoogle ScholarPubMed
Ruta, L, Mazzone, D, Mazzone, L, et al. The autism-spectrum quotient—Italian version: a cross-cultural confirmation of the broader autism phenotype. J Autism Dev Disord. 2012;42(4):625–633.CrossRefGoogle ScholarPubMed
Delorme, R, Gousse, V, Roy, I, et al. Shared executive dysfunctions in unaffected relatives of patients with autism and obsessive compulsive disorder. Eur Psychiatry. 2007;22(1):32–38.CrossRefGoogle ScholarPubMed
Briskman, J, Happe, F, Frith, U. Exploring the cognitive phenotype of autism: weak "central coherence" in parents and siblings of children with autism: II. Real-life skills and preferences. J Child Psychol Psychiatry. 2001;42(3):309–316.CrossRefGoogle ScholarPubMed
Robel, L, Rousselot-Pailley, B, Fortin, C, et al. Subthreshold traits of the broad autistic spectrum are distributed across different subgroups in parents, but not siblings, of probands with autism. Eur Child Adolesc Psychiatry. 2014;23(4):225–233.CrossRefGoogle Scholar
Bailey, A, Palferman, S, Heavey, L, et al. Autism: the phenotype in relatives. J Autism Dev Disord. 1998;28(5):369–392.CrossRefGoogle ScholarPubMed
Yirmiya, N, Shaked, M. Psychiatric disorders in parents of children with autism: a meta-analysis. J Child Psychol Psychiatry. 2005;46(1):69–83.Google ScholarPubMed
Ruzich, E, Allison, C, Smith, P, et al. Subgrouping siblings of people with autism: identifying the broader autism phenotype. Autism Res. 2016;9(6):658–665.CrossRefGoogle ScholarPubMed
Happé, F. An advanced test of Theory of Mind: understanding of story characters’ thoughts and feelings by able autistic, mentally handicapped, and normal children and adults. J Autism Dev Disord. 1994;24(2):129–154.Google ScholarPubMed
Baron-Cohen, S, Jolliffe, T, Mortimore, C, et al. Another advanced test of Theory of Mind: evidence from very high functioning adults with autism or Asperger syndrome. J Child Psychol Psychiatry. 1997:38(7):813–822.CrossRefGoogle ScholarPubMed
Baron-Cohen, S, Wheelwright, S. The “reading the mind in the eyes” test revised version: a study with normal adults, and adults with Asperger Syndrome or high-functioning autism. J Child Psychol Psychiatry. 2001;42(2):241–251.CrossRefGoogle ScholarPubMed
White, S, Hill, E, Happé, F, et al. Revisiting the strange stories: revealing mentalizing impairments in autism. Child Dev. 2009;80(4):1097–1117.CrossRefGoogle ScholarPubMed
Ozonoff, S, Rogers, SJ, Farnham, JM, et al. Can standard measures identify subclinical markers of autism? J Autism Develop Disord. 1993;23(3):429–441.CrossRefGoogle ScholarPubMed
Piven, J. The biological basis of autism. Curr Opin Neurobiol. 2008;7(5):708–712.CrossRefGoogle Scholar
Dell’Osso, L, Dalle Luche, R, Cerliani, C, et al. Unexpected subthreshold autism spectrum in a 25-year-old male stalker hospitalized for delusional disorder: a case report. Compr Psychiatry. 2015;61:10–14.CrossRefGoogle Scholar
Dell’Osso, L, Gesi, C, Carmassi, C. Suicide and autism spectrum disorder: the role of trauma. J Psychopathol. 2016;22(2):107–109.Google Scholar
Dell’Osso, L, Luche, RD, Gesi, C, et al. From Asperger’s Autistischen psychopathen to DSM-5 autism spectrum disorder and beyond: a subthreshold autism spectrum model. Clin Pract Epidemiol Ment Health. 2016;12:120–131.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Abelli, M, Carpita, B, et al. Historical evolution of the concept of anorexia nervosa and relationships with orthorexia nervosa, autism, and obsessive–compulsive spectrum. Neuropsych Dis Treat. 2016;12:1651–1660.Google ScholarPubMed
Carbone, M, Miniati, M, Simoncini, M, et al. Undetected autism subthreshold spectrum as risk factor for suicidal gestures in adulthood: a case report. J Psychopathol. 2018;24:37–40.Google Scholar
Dell’Osso, L, Muti, D, Carpita, B, et al. The Adult Autism Subthreshold Spectrum (AdAS) model: a neurodevelopmental approach to mental disorders. J Psychopathol. 2018;24:118–124.Google Scholar
Dell’Osso, L, Cremone, IM, Carpita, B, et al. Correlates of autistic traits among patients with borderline personality disorder. Compr Psychiatry. 2018;83:7–11.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Carpita, B, Cremone, IM, et al. The mediating effect of trauma and stressor related symptoms and ruminations on the relationship between autistic traits and mood spectrum. Psychiatry Res. 2018;279:123–129.Google ScholarPubMed
Dell’Osso, L, Conversano, C, Corsi, M, et al. Polysubstance and behavioral addictions in a patient with bipolar disorder: role of lifetime subthreshold autism spectrum. Case Rep Psychiatry. 2018;2018:1547975.Google Scholar
Dell’Osso, L, Carpita, B, Muti, D, et al. Prevalence and characteristics of orthorexia nervosa in a sample of university students in Italy. Eat Weight Disord. 2018;23(1):55–65.Google Scholar
Dell’Osso, L, Corsi, M, Gesi, C, et al. Adult Autism Subthreshold Spectrum (AdAS Spectrum) in parents of pediatric patients with epilepsy: correlations with post-traumatic stress symptoms. Compr Psychiatry. 2018;83:25–30.Google ScholarPubMed
Dell’Osso, L, Carpita, B, Muti, D, et al. Mood symptoms and suicidality across the autism spectrum. Compr Psychiatry. 2019;91:34–38.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Bertelloni, CA, Di Paolo, M, et al. Problematic Internet use in university students attending three superior graduate schools in Italy: is autism spectrum related to suicide risk? Int J Environ Res Public Health. 2019;16(7):1098.CrossRefGoogle ScholarPubMed
Jobe, LE, White, SW. Loneliness, social relationships, and a broader autism phenotype in college students. Pers Individ Diff. 2007;42(8):1479–1489.CrossRefGoogle Scholar
Trevisan, D, Birmingham, E. Examining the relationship between autistic traits and college adjustment. Autism. 2016;20(6):719–729.Google ScholarPubMed
Wallace, GL, Budgett, J, Charlton, RA. Aging and autism spectrum disorder: evidence from the broad autism phenotype. Autism Res. 2016;9(12):1294–1303.CrossRefGoogle ScholarPubMed
Suzuki, T, Miyaki, K, Eguchi, E, et al. Distribution of autistic traits and their association with sociodemographic characteristics in Japanese workers. Autism. 2018;22(8):907–914.CrossRefGoogle ScholarPubMed
Ooi, KL, Ong, YS, Jacob, SA, et al. A metasynthesis on parenting a child with autism. Neuropsychiatr Dis Treat. 2016;12:745–762.Google Scholar
DeLong, RT, Dwyer, JT. Correlation of family history with specific autistic subgroups: Asperger’s syndrome and bipolar affective disease. J Autism Develop Disord. 1988;12(4):593–60.CrossRefGoogle Scholar
Piven, J, Chase, GA, Landa, R, et al. Psychiatric disorders in the parents of autistic individuals. J Am Acad Child Adolesc Psychiatry. 1991;30(3):471–478.CrossRefGoogle ScholarPubMed
Dumas, JE, Wolf, LC, Fisman, SN, et al. Parenting stress, child behaviour problems, and dysphoria in parents of children with autism, Down syndrome, behaviour disorders, and normal development. Exceptionality. 1991;2(2):97–110.CrossRefGoogle Scholar
Bolton, PF, Pickles, A, Murphy, M, et al. Autism, affective and other psychiatric disorders: patterns of familial aggregation. Psychol Med. 1998;28(2):385–395.CrossRefGoogle ScholarPubMed
Goussé, V, Galéra, C, Bouvard, M, et al. Aggregation of social deficits and psychiatric disorders in parents of children with autism: toward a temperamental link? Encephale. 2011;37(2):119–126.CrossRefGoogle Scholar
Micali, N, Chakrabarti, S, Fombonne, E. The broad autism phenotype Autism. 2004;8(1):21–37.CrossRefGoogle ScholarPubMed
Ingersoll, B, Hambrick, DZ. The relationship between the broader autism phenotype, child severity, and stress and depression in parents of children with autism spectrum disorders. Res Autism Spectr Disord. 2011;5(1):337–344.CrossRefGoogle Scholar
Piven, J, Palmer, P. Psychiatric disorder and the broad autism phenotype: evidence from a family study of multiple-incidence autism families. Am J Psychiatry. 1999;156(4):557–563.Google ScholarPubMed
Wilcox, JA, Tsuang, MT, Schnurr, T, et al. Case-control family study of lesser variant traits in autism. Neuropsychobiology. 2003;47(4):171–177.CrossRefGoogle ScholarPubMed
O’Neill, LP, Murray, LE. Anxiety and depression symptomatology in adult siblings of individuals with different developmental disability diagnoses. Res Dev Disabil. 2016;51–52:116–125.CrossRefGoogle ScholarPubMed
Marazziti, D, Baroni, S, Giannaccini, G, et al. A link between oxytocin and serotonin in humans: supporting evidence from peripheral markers. Eur Neuropsychopharmacol. 2012;22(8):578–583.CrossRefGoogle ScholarPubMed
Marazziti, D, Abelli, M, Baroni, S, et al. Recent findings on the pathophysiology of social anxiety disorder. Clin Neuropsychiatry. 2014;11(2):91–100.Google Scholar
Attwood, T. Asperger’s and Girls. Arlington, TX: Future Horizons; 2006.Google Scholar
Nolen-Hoeksema, S, Wisco, BE, Lyubomirsky, S. Rethinking rumination. Perspect Psychol Sci. 2008;3(5):400–424.CrossRefGoogle ScholarPubMed
Watkins, ER. Depressive rumination and co-morbidity: evidence for brooding as a transdiagnostic process. J Ration Emot Cogn Behav Ther. 2009;27(3):160–175.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Cremone, IM, Carpita, B, et al. Rumination, posttraumatic stress disorder, and mood symptoms in borderline personality disorder. Neuropsychiatr Dis Treat. 2019;15:1231–1238.CrossRefGoogle ScholarPubMed
Teismann, T, Forkmann, T. Positive mental health moderates the association between depression and suicide ideation: a longitudinal study. Int J Clin Health Psychol. 2018;18(1):1–7.CrossRefGoogle ScholarPubMed
Law, KC, Tucker, RP. Repetitive negative thinking and suicide: a burgeoning literature with need for further exploration. Curr Opin Psychol. 2018;22:68–72.CrossRefGoogle ScholarPubMed
Mayes, SD, Gorman, AA, Hillwig-Garcia, J, et al. Suicide ideation and attempts in children with autism. Res Autism Spectr Disord. 2013;7(1):109–119.CrossRefGoogle Scholar
Dell’Osso, L, Gesi, C, Massimetti, E, et al. Adult Autism Subthreshold Spectrum (AdAS Spectrum): validation of a questionnaire investigating subthreshold autism spectrum. Compr Psychiatry. 2017;73:61–83.CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S, Morrow, J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. J Pers Soc Psychol. 1991;61(1):115–121.CrossRefGoogle ScholarPubMed
Parola, N, Zendjidjian, XY, Alessandrini, M, et al. Psychometric properties of the Ruminative Response Scale-short form in a clinical sample of patients with major depressive disorder. Patient Prefer Adherence. 2017;11:929–937.CrossRefGoogle Scholar
Goldman, HH, Skodol, AE, Lave, TR. Revising axis V for DSM-IV: a review of measures of social functioning. Am J Psychiatry. 1992;149(9):1148–1156.Google ScholarPubMed
Faravelli, C, Guerrini Degl’Innocenti, B, Aiazzi, L, et al. Epidemiology of mood disorders: a community survey in Florence. J Affect Disord. 1990;20(2):135–141.CrossRefGoogle ScholarPubMed
de Girolamo, G, Polidori, G, Morosini, P, et al. Prevalence ofcommon mental disorders in Italy: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD). Soc Psychiatry Psychiatr Epidemiol. 2006;41(11):853–861.CrossRefGoogle Scholar
Faravelli, C, Abrardi, L, Bartolozzi, D, et al. The Sesto Fiorentino Study: background, methods and preliminary results. Psychother Psychosom. 2004;73(4):216–225.CrossRefGoogle ScholarPubMed
August, G, Stewart, M, Tsai, L. The incidence of cognitive disabilities in the siblings of autistic children. Br J Psychiatry. 1981;138(5):416–422.CrossRefGoogle ScholarPubMed
Hastings, RP. Parental stress and behaviour problems of children with developmental disability. J Intellect Dev Disabil.2002;27(3):149–160.CrossRefGoogle Scholar
Benson, PR. The impact of child symptom severity on depressed mood among parents of children with ASD: the mediating role of stress proliferation. J Autism Dev Disord. 2006;36(5):685–695.CrossRefGoogle ScholarPubMed
Hayes, SA, Watson, SL. The impact of parenting stress: a meta-analysis of studies comparing the experience of parenting stress in parents of children with and without autism spectrum disorder. J Autism Dev Disord. 2013;43(3):629–642.CrossRefGoogle ScholarPubMed
Ingersoll, B, Meyer, K, Becker, MW. Increased rates of depressive mood in mothers of children with ASD associated with the presence of the broader autism phenotype. Autism Res. 2010;4(2):143–148.CrossRefGoogle ScholarPubMed
Lau, WY, Gau, SS, Chiu, YN, et al. Autistic traits in couple dyads as a predictor of anxiety spectrum symptoms. J Autism Dev Disord. 2014;44(11):2949–2963.CrossRefGoogle ScholarPubMed
Pruitt, MM, Rhoden, M, Ekas, NV. Relationship between the broad autism phenotype, social relationships and mental health for mothers of children with autism spectrum disorder. Autism. 2018;22(2):171–180.CrossRefGoogle ScholarPubMed
Aron, E, Aron, A, Jagiellowicz, J. Sensory processing sensitivity: a review in the light of the evolution of biologicalresponsivity. Pers Soc Psychol Rev. 2012;16(3):262–282.CrossRefGoogle Scholar
Carleton, RN. Into the unknown: a review and synthesis of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30–43.CrossRefGoogle ScholarPubMed
McEvoy, P, Mahoney, AEJ. Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. J Anxiety Disord. 2011;25(1):112–122.CrossRefGoogle Scholar
Wigham, S, Rodgers, J, South, M, et al. The interplay between sensory processing abnormalities, intolerance of uncertainty, anxiety and restricted and repetitive behaviours in autism spectrum disorder. J Autism Develop Disord. 2015;45(4):943–952.CrossRefGoogle ScholarPubMed
Uljarević, M, Carrington, S, Leekam, S. Brief report effects of sensory sensitivity and intolerance of uncertainty on anxiety in mothers of children with autism spectrum disorder. J Autism Develop Disord. 2016;46(1):315–319.CrossRefGoogle ScholarPubMed
Boyd, B. Examining the relationship between stress and lack of social support in mothers of children with autism. Focus Autism Other Dev Disabil. 2002;17(4):208–215.CrossRefGoogle Scholar
Benson, PR, Kersh, J. Marital quality and psychological adjustment among mothers of children with ASD: cross-sectional and longitudinal relationships. J Autism Dev Disord. 2011;41(12):1675–1685.CrossRefGoogle ScholarPubMed
Pelton, MK, Cassidy, SA. Are autistic traits associated with suicidality? A test of the interpersonal-psychological theory of suicide in a non-clinical young adult sample. Autism Res. 2018;10(11):1891–1904.CrossRefGoogle Scholar
Carmassi, C, Bertelloni, CA, Salarpi, G, et al. Is there a major role for undetected autism spectrum disorder with childhood trauma in a patient with a diagnosis of bipolar disorder, self-injuring, and multiple comorbidities? Case Rep Psychiatry. 2019;2019:4703795.Google Scholar
Ruser, TF, Arin, D, Dowd, M, et al. Communicative competence in parents of children with autism and parents of children with specific language impairment. J Autism Develop Disord. 2007;37(7):1323–1336.CrossRefGoogle ScholarPubMed
Landa, R, Piven, J, Wzorek, MM, et al. Social language use in parents of autistic individuals. Psychol Med. 1992;22(1):245–254.CrossRefGoogle ScholarPubMed
Dabrowska, A, Pisula, E. Parenting stress and coping styles in mothers and fathers of pre-school children with autism and Down syndrome. J Intellect Disabil Res. 2010;54(3):266–280.CrossRefGoogle ScholarPubMed
Al Kandari, S, Alsalem, A, Abohaimed, S, et al. Brief report: social support and coping strategies of mothers of children suffering from ASD in Kuwait. J Autism Dev Disord. 2017;47(10):3311–3319.CrossRefGoogle ScholarPubMed
Carmassi, C, Corsi, M, Bertelloni, CA, et al. Mothers and fathers of children with epilepsy: gender differences in post-traumatic stress symptoms and correlations with mood spectrum symptoms. Neuropsychiatr Dis Treat. 2018;14:1371–1379.CrossRefGoogle ScholarPubMed
Dell’Osso, L, Dalle Luche, R, Carmassi, C. A new perspective in post-traumatic stress disorder: which role for unrecognized autism spectrum? Int J Emerg Mental Health Hum Resil. 2015;17:436–438.Google Scholar
Carmassi, C, Corsi, M, Bertelloni, CA, et al. Post-traumatic stress and major depressive disorders in parent caregivers of children with a chronic disorder. Psychiatry Res. 2019;279:195–200.CrossRefGoogle ScholarPubMed
Geurts, HM, Bergh, SF, Ruzzano, L. Prepotent response inhibition and interference control in autism spectrum disorders: two meta-analyses. Autism Res. 2014;7(4):407–420.CrossRefGoogle ScholarPubMed
Siegle, GJ, Moore, PM, Thase, ME. Rumination: one construct, many features in healthy individuals, depressed individuals, and individuals with lupus. Cognit Ther Res. 2004;28(5):645–668.CrossRefGoogle Scholar
Dell’Osso, L, Del Grande, C, Gesi, C, et al. A new look at an old drug: neuroprotective effects and therapeutic potentials of lithium salts. Neuropsychiatr Dis Treat. 2016;12:1687–1703.Google Scholar
Carmassi, C, Palagini, L, Caruso, D, et al. Systematic review of sleep disturbances and circadian sleep desynchronization in autism spectrum disorder: toward an integrative model of a self-reinforcing loop. Front Psychiatry. 2019;10:366.CrossRefGoogle ScholarPubMed