Article Figures & Data
Tables
- Table 1
Comparison of Developmental History, Co-Occurring Difficulties, Presenting Behaviors, and Cognition between ASD and ASPD
History, Co-Occurring Difficulties, Behavior, and Cognition Typical Presentation in Autism Spectrum Disorders ASPD Developmental history where known Pattern of developmental disturbance such as with speech and language development (sometimes delayed), play (often a lack of make-believe play with others), preoccupations, motor coordination difficulties, and atypical sensory function No evidence of delayed early motor, language, or social development. Conduct disorder is common. This is a currently a requirement for the diagnosis of ASPD in the DSM-5 (but not the ICD-10). Adverse early life experiences Children with development disabilities had 1.5- to 3-fold higher risk of maltreatment compared to neurotypical controls.32,33 ASPD is associated with adverse early life experiences. One study found that the severity of childhood maltreatment was linked to severity of psychopathy and ASPD in adulthood.34 Psychiatric comorbidity Affective, anxiety and psychotic disorders are more common in those with ASDs compared to the general population. Anxiety disorders are common. The combination of anxiety disorders and ASPD may predispose to depressive and substance use disorders.35 Presence of other neurodevelopmental disorders Estimates in children with ASDs suggest comorbidity is more common than not, including ADHD, tic disorder, intellectual disabilities, and obsessive-compulsive disorder.36 ADHD is common in children with conduct disorder and increases the risk of developing ASPD in adulthood.37 Sensory functioning Altered sensory sensitivity is common across a range of stimuli (light, sounds, textures, etc.). This usually manifests as sensory hypersensitivities and sensory avoidance. No evidence that altered sensory sensitivities are characteristic. Social communication difficulties during interviews Common features include a lack of intonation, literal interpretation of comments, unusual eye contact, repetitive behaviors, and difficulties with reciprocal discussions. Often one-sided interactions, but no difference in speech, use of language and nonverbal communication compared with the general population. Personal need for routine and predictability in the immediate environment Often very important for an individual, with any deviation resulting in heightened anxiety levels Not usually present or associated with impaired function. If deviation of personal routines occurs, however, this may be viewed as a personal insult or injustice. Preoccupations and restricted range of interests Tendency to develop preoccupations and have a restricted range of interests Preoccupations typically related to perceived critical comments and actions to self rather than to nonpersonal interests. Emotion regulation Difficulties in emotional regulation are common, including alexithymia Difficulties in emotional regulation are common, including being quick to anger and hostility in response to personal stresses or perceived criticisms. Neuropsychological characteristics and thinking style Difficulties with central cohesion (failing to appreciate the bigger picture) and a tendency for literal thinking and problems generalizing (learning from one situation to another) are common No overt profile of any neuropsychological difficulties; however some features of executive dysfunction may be present, including difficulties with attention, working memory and planning, inhibitory control and response reversal, which manifest in impulsivity and short-term thinking.38 Empathy (the ability to understand and share the emotions and feelings of others) Deficits in cognitive empathy (Theory of Mind and perspective taking) relative to affective empathy are noted. Deficits in affective empathy are more notable. Mentalization Theory of Mind deficits that can lead to difficulties in perspective taking and understanding the thoughts and feelings of others and how this influences behavior Tendency for negative interpretations of others' motives and behavior that may be used as justification for one's own behavior in response. Attitudes towards others and society in general Often expressed as a need for others to follow consistent rules and fairness Tends to hold a critical view of the intentions of others, or that if other people step out of line, criticisms and negative consequences are justified. ADHD = attention-deficit hyperactivity disorder; ASD = autism spectrum disorder; ASPD = antisocial personality disorder.
