The autism diagnostic observation schedule: Patterns in individuals with anorexia nervosa

Abstract

Objective Studies have used the Autism Diagnostic Observation Schedule (the ADOS‐2) in individuals with anorexia nervosa (AN), but the patterns of scores have not been assessed. We examined which subset of the ADOS‐2 items best discriminate individuals with AN from healthy controls (HC), and assessed the potential clustering of AN participants based on different profiles of the ADOS‐2 item scores. Method We combined datasets from two previous studies, and (a) compared mean ranks between young AN participants (N = 118) and HC (N = 42), (ii) replicated the item selection procedure of the existing ADOS‐2 algorithm to assess sensitivity of items in the AN group, and (c) applied a two‐step clustering analysis in the AN group (N = 149). Results AN participants displayed significantly higher mean ranks than HC participants in five of 32 items. All five items are part of the existing ADOS‐2 algorithm. We found two clusters of AN participants; one representing normal social behaviour, comprising 68% of the individuals with AN, and one representing less efficient social behaviour, comprising 32% of individuals with AN. Conclusions The items comprising the social affective cluster of the existing ADOS‐2 algorithm are well suited to assess difficulties with social functioning in individuals with AN.

Autism symptoms in anorexia nervosa: a comparative study with females with autism spectrum disorder

“…Although women with ASD also report similar difficulties with exclusion and anxiety, they also report frequent mistakes and misunderstandings of typical social conventions [ 23 ]. While patients with AN often appear withdrawn and socially anxious, it seems that only a minority of patients show difficulties in understanding the to and fro of conversation, or with responding appropriately to social prompts [ 64 ]. These individuals may indeed meet diagnostic criteria for ASD.…”

“…This approach was used in a previous study addressing a similar research question [ 63 ]. TD were not included in the item endorsement analyses, as discriminating between ASD and TD, as well as AN and TD using the ADOS-2 was not the purpose of this study and has been covered elsewhere [ 52 , 53 , 64 ]. A significance level of α = 0.01 was used across analyses, however no correction was applied to account for multiple comparisons [ 65 ].…”

Autistic Traits and Social Responsiveness: The Relationship Between Autistic Traits and Comorbid Psychiatric Symptoms in Adolescents With Anorexia Nervosa

“…Another key finding of this study is that although adolescents with AN were found to score significantly higher than HCs on the SRS, the scores were not high enough to meet the indicated cut-off point for ASD. While these difficulties may not be severe enough to diagnose ASD, they could still leave an individual vulnerable to the development of AN ( 48 ) and may have impact on treatment outcome, making them clinically relevant ( 7 , 11 , 49 ). Although the SRS, has been established to have high reliability and validity, to be significantly correlated with the diagnosis of autism made using the Autism Diagnostic Interview-Revised and can be used with the aim of evaluating autism-like symptom clusters ( 32 , 50 , 51 ), it has not previously been used to determine autistic traits in adolescents with AN.…”

“…Both conditions share a common profile of resistance to changes, social withdrawal and social disengagement, and show similar patterns of neurocognitive dysfunction including impaired set-shifting, weak central coherence, and impaired theory-of-mind (ToM) abilities ( 6 , 9 ). Patients with AN have also poor social and emotional functioning ( 10 , 11 ), including interpersonal relationship problems ( 7 ), reduced facial emotion expression ( 12 ), impaired facial emotion recognition ( 13 ), difficulties identifying emotions ( 10 ) and social anhedonia ( 3 ). As a result, the studies based on experimental data and clinical observations show that these cognitive, socio-emotional and interpersonal problems may be both a cause and a contributing factor in the course of the disease ( 14 ).…”

“…As a result, the studies based on experimental data and clinical observations show that these cognitive, socio-emotional and interpersonal problems may be both a cause and a contributing factor in the course of the disease ( 14 ). It is therefore possible that the presence of underlying ASD traits effectively maintains AN ( 7 , 11 ). On the other hand, deterioration in social and emotional functioning in the course of AN is also associated with longer duration of disease, increase in disease severity, and poorer treatment outcome ( 3 , 15 , 16 ).…”