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Anorexia nervosa and autism : a prospective twin cohort study

Dinkler, Lisa ; Taylor, Mark J. ; Råstam, Maria LU ; Hadjikhani, Nouchine ; Bulik, Cynthia M. ; Lichtenstein, Paul ; Gillberg, Christopher and Lundström, Sebastian LU (2021) In Journal of Child Psychology and Psychiatry and Allied Disciplines 62(3). p.316-326
Abstract

Background: Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. Methods: In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and... (More)

Background: Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. Methods: In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). Results: We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. Conclusions: Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anorexia nervosa, autism spectrum disorders, Eating disorder, longitudinal studies
in
Journal of Child Psychology and Psychiatry and Allied Disciplines
volume
62
issue
3
pages
316 - 326
publisher
Wiley-Blackwell
external identifiers
  • pmid:32496594
  • scopus:85085888156
ISSN
0021-9630
DOI
10.1111/jcpp.13265
language
English
LU publication?
yes
id
852ef18f-c491-431d-b7f0-fb40b064dfa8
date added to LUP
2020-07-02 16:29:16
date last changed
2021-04-16 17:37:25
@article{852ef18f-c491-431d-b7f0-fb40b064dfa8,
  abstract     = {<p>Background: Anorexia nervosa (AN) and autism spectrum disorder (ASD) may be phenotypically and etiologically linked. However, due to the absence of prospective studies, it remains unclear whether the elevation of autistic traits in AN is evident in early childhood. Here, we prospectively investigated autistic traits before and after the first diagnosis of AN. Methods: In a population-based sample of 5,987 individuals (52.4% female) from the Child and Adolescent Twin Study in Sweden, parents reported autistic traits at ages 9 and 18. AN and ASD diagnoses were retrieved from the Swedish National Patient Register. In addition, AN diagnoses were ascertained by parent-reported treatment for AN. We compared whether individuals with and without AN differed in autistic traits before the first diagnosis of AN (age 9) and after the first diagnosis of AN (age 18). Results: We did not find evidence for elevated autistic traits in 9-year-old children later diagnosed with AN. At age 18, however, there was a marked elevation in restricted/repetitive behavior and interests, but only in the subgroup of individuals with acute AN. A less pronounced elevation was observed for social communication problems. Conclusions: Coping strategies in individuals with ASD and the somewhat different female ASD phenotype may explain why we did not find elevated autistic traits in children who later developed AN. Alternatively, it is possible that elevated autistic traits were not present prior to the onset of AN, thus questioning the previously reported elevated prevalence of ASD in AN. Future studies should use tailored measurements in order to investigate whether autistic traits in individuals with AN are best conceptualized as an epiphenomenon of the acute AN phase or whether these symptoms indeed represent ASD as a clinically verifiable neurodevelopmental disorder.</p>},
  author       = {Dinkler, Lisa and Taylor, Mark J. and Råstam, Maria and Hadjikhani, Nouchine and Bulik, Cynthia M. and Lichtenstein, Paul and Gillberg, Christopher and Lundström, Sebastian},
  issn         = {0021-9630},
  language     = {eng},
  number       = {3},
  pages        = {316--326},
  publisher    = {Wiley-Blackwell},
  series       = {Journal of Child Psychology and Psychiatry and Allied Disciplines},
  title        = {Anorexia nervosa and autism : a prospective twin cohort study},
  url          = {http://dx.doi.org/10.1111/jcpp.13265},
  doi          = {10.1111/jcpp.13265},
  volume       = {62},
  year         = {2021},
}