| 1. |
- Brimo, Katarzyna, et al.
(författare)
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The co-occurrence of neurodevelopmental problems in dyslexia
- 2021
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Ingår i: Dyslexia. - : Wiley. - 1076-9242 .- 1099-0909. ; 27:3, s. 277-293
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Tidskriftsartikel (refereegranskat)abstract
- The primary aim of this study was to explore the overlaps between dyslexia and a range of neurodevelopmental disorders and problems (NDPs), specifically symptoms of attention-deficit/hyperactivity disorder, autism spectrum disorder, atypical sensory perception and developmental coordination disorder. Capitalizing on a population-based sample of twins, secondary aims included estimating the heritability of dyslexia and reporting on the measurement characteristics of the scale used to assess dyslexia. A telephone interview regarding symptoms of dyslexia and other NDPs was conducted with parents of 1,688 nine-year-old twins. The prevalence and the heritability of dyslexia were estimated at 8 and 52%, respectively. The boy: girl ratio was 1.5:1. Results revealed that there was more than an eightfold increase in (diagnostic proxy) NDPs prevalence in the dyslexia group as compared to typical readers. Quantitatively measured symptoms of inattention, oral language problems and atypical sensory perception significantly predicted dyslexia status in a multivariate analysis. By contrast, ASD-related inflexibility was inversely associated with dyslexia in the multivariate model. In sum, dyslexia often overlaps with other NDPs. The current study provides new knowledge supporting the position to move beyond isolated diagnostic categories into behavioural profiles of co-occurring problems when trying to understand the pattern of strengths and needs in individuals with dyslexia.
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| 2. |
- Dinkler, Lisa, et al.
(författare)
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Anorexia nervosa and autism: a prospective twin cohort study
- 2021
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Ingår i: Journal of Child Psychology and Psychiatry and Allied Disciplines. - : Wiley. - 0021-9630 .- 1469-7610. ; 62:3, s. 316-326
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Tidskriftsartikel (refereegranskat)abstract
- © 2020 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health. 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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| 3. |
- Dinkler, Lisa, et al.
(författare)
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Assessment of avoidant restrictive food intake disorder, pica and rumination disorder: interview and questionnaire measures
- 2021
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Ingår i: Current Opinion in Psychiatry. - : Ovid Technologies (Wolters Kluwer Health). - 0951-7367 .- 1473-6578. ; 34:6, s. 532-542
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Tidskriftsartikel (refereegranskat)abstract
- Purpose of review This article reviews available assessment instruments for three of the feeding and eating disorder diagnostic categories: avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD). It includes an overview of the current status of screening tools, questionnaire measures, and diagnostic instruments. Recent findings Screening instruments are available for all three disorders; however, for pica and RD, these typically include single screening items only and do not cover any specific features of these presentations. Only one questionnaire suitable for clinical populations is included, covering ARFID only. Standardized diagnostic interviews are limited to two covering both pica and RD, only one of which provides further clinical information. Of the five diagnostic instruments for ARFID described here, two include diagnostic items as well as allowing more detailed assessment of clinical features. There are a limited number of assessment measures available for all three disorders, with instruments for ARFID being the greatest in number and widest in terms of scope. A commonly encountered difficulty is that many assessment instruments do not adequately cover diagnostic exclusion criteria, which raises the likelihood of false positive findings. All currently available measures require further study to determine their reliability and validity.
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| 4. |
- Dinkler, Lisa, et al.
(författare)
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Association of etiological factors across the extreme end and continuous variation in disordered eating in female Swedish twins
- 2021
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Ingår i: Psychological Medicine. - 0033-2917 .- 1469-8978. ; 51:5, s. 750-760
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundAccumulating evidence suggests that many psychiatric disorders etiologically represent the extreme end of dimensionally distributed features rather than distinct entities. The extent to which this applies to eating disorders (EDs) is unknown.MethodsWe investigated if there is similar etiology in (a) the continuous distribution of the Eating Disorder Inventory-2 (EDI-2), (b) the extremes of EDI-2 score, and (c) registered ED diagnoses, in 1481 female twin pairs at age 18 years (born 1992-1999). EDI-2 scores were self-reported at age 18. ED diagnoses were identified through the Swedish National Patient Register, parent-reported treatment and/or self-reported purging behavior of a frequency and duration consistent with DSM-IV criteria. We differentiated between anorexia nervosa (AN) and other EDs.ResultsThe heritability of the EDI-2 score was 0.65 (95% CI 0.61-0.68). The group heritabilities in DeFries-Fulker extremes analyses were consistent over different percentile-based extreme groups [0.59 (95% CI 0.37-0.81) to 0.65 (95% CI 0.55-0.75)]. Similarly, the heritabilities in liability threshold models were consistent over different levels of severity. In joint categorical-continuous models, the twin-based genetic correlation was 0.52 (95% CI 0.39-0.65) between EDI-2 score and diagnoses of other EDs, and 0.26 (95% CI 0.08-0.42) between EDI-2 score and diagnoses of AN. The non-shared environmental correlations were 0.52 (95% CI 0.32-0.70) and 0.60 (95% CI 0.38-0.79), respectively.ConclusionsOur findings suggest that some EDs can partly be conceptualized as the extreme manifestation of continuously distributed ED features. AN, however, might be more distinctly genetically demarcated from ED features in the general population than other EDs.
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| 5. |
- Dinkler, Lisa, et al.
(författare)
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Development of a parent-reported screening tool for avoidant/restrictive food intake disorder (ARFID): Initial validation and prevalence in 4-7-year-old Japanese children
- 2022
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Ingår i: Appetite. - : Elsevier BV. - 0195-6663. ; 168
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Tidskriftsartikel (refereegranskat)abstract
- The prevalence of avoidant/restrictive food intake disorder (ARFID) in the general child population is still largely unknown and validated screening instruments are lacking. The aims of this study were (1) to investigate the prevalence of children screening positive for ARFID in a Japanese birth cohort using a newly developed parent-reported screening tool, (2) to estimate the prevalence of children with ARFID experiencing physical versus psychosocial consequences of their eating pattern, and (3) to provide preliminary evidence for the validity of the new screening tool. Data were collected from 3728 4-7-year-old children born between 2011 and 2014 in Kochi prefecture, Japan (response rate was 56.5%); a sub-sample of the Japan Environment and Children's Study (JECS). Parents completed a questionnaire including the ARFID screener and several other measures to assess convergent validity. The point prevalence of children screening positive for ARFID was 1.3%; half of them met criteria for ARFID based on psychosocial impairment alone, while the other half met diagnostic criteria relating to physical impairment (and additional psychosocial impairment in many cases). Sensory sensitivity to food characteristics (63%) and/or lack of interest in eating (51%) were the most prevalent drivers of food avoidance. Children screening positive for ARFID were lighter in weight and shorter in height, they showed more problem behaviors related to mealtimes and nutritional intake, and they were more often selective eaters and more responsive to satiety, which together provides preliminary support for the validity of the new screening tool. This is the largest screening study to date of ARFID in children up to 7 years. Future studies should examine the diagnostic validity of the new ARFID screener using clinically ascertained cases. Further research on ARFID prevalence in the general population is needed.
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| 6. |
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| 7. |
- Dinkler, Lisa, et al.
(författare)
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Etiology of the Broad Avoidant Restrictive Food Intake Disorder Phenotype in Swedish Twins Aged 6 to 12 Years
- 2023
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Ingår i: JAMA psychiatry. - : American Medical Association. - 2168-6238 .- 2168-622X. ; 80:3, s. 260-269
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Tidskriftsartikel (refereegranskat)abstract
- IMPORTANCE: Avoidant restrictive food intake disorder (ARFID) is characterized by an extremely limited range and/or amount of food eaten, resulting in the persistent failure to meet nutritional and/or energy needs. Its etiology is poorly understood, and knowledge of genetic and environmental contributions to ARFID is needed to guide future research. OBJECTIVE: To estimate the extent to which genetic and environmental factors contribute to the liability to the broad ARFID phenotype.DESIGN, SETTING, AND PARTICIPANTS: This nationwide Swedish twin study includes 16 951 twin pairs born between 1992 and 2010 whose parents participated in the Child and Adolescent Twin Study in Sweden (CATSS) at twin age 9 or 12 years. CATSS was linked to the National Patient Register (NPR) and the Prescribed Drug Register (PDR). Data were collected from July 2004 to April 2020, and data were analyzed from October 2021 to October 2022.MAIN OUTCOMES AND MEASURES: From CATSS, NPR, and PDR, all parent reports, diagnoses, procedures, and prescribed drugs that were relevant to the DSM-5 ARFID criteria were extracted when twin pairs were aged 6 to 12 years and integrated into a composite measure for the ARFID phenotype (ie, avoidant/restrictive eating with clinically significant impact, such as low weight or nutritional deficiency, and with fear of weight gain as an exclusion). In sensitivity analyses, autism and medical conditions that could account for the eating disturbance were controlled for. Univariate liability threshold models were fitted to estimate the relative contribution of genetic and environmental variation to the liability to the ARFID phenotype.RESULTS: Of 33 902 included children, 17 151 (50.6%) were male. A total of 682 children (2.0%) with the ARFID phenotype were identified. The heritability of ARFID was 0.79 (95% CI, 0.70-0.85), with significant contributions from nonshared environmental factors (0.21; 95% CI, 0.15-0.30). Heritability was very similar when excluding children with autism (0.77; 95% CI, 0.67-0.84) or medical illnesses that could account for the eating disturbance (0.79; 95% CI, 0.70-0.86).CONCLUSIONS AND RELEVANCE: Prevalence and sex distribution of the broad ARFID phenotype were similar to previous studies, supporting the use of existing epidemiological data to identify children with ARFID. This study of the estimated genetic and environmental etiology of ARFID suggests that ARFID is highly heritable, encouraging future twin and molecular genetic studies.
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| 8. |
- Dinkler, Lisa, et al.
(författare)
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Maltreatment-associated neurodevelopmental disorders : a co-twin control analysis
- 2017
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Ingår i: Journal of Child Psychology and Psychiatry. - Stockholm : Karolinska Institutet, Dept of Medical Epidemiology and Biostatistics. - 0021-9630 .- 1469-7610.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Childhood maltreatment (CM) is strongly associated with psychiatric disorders in childhood and adulthood. Previous findings suggest that the association between CM and psychiatric disorders is partly causal and partly due to familial confounding, but few studies have investigated the mechanisms behind the association between CM and neurodevelopmental disorders (NDDs). Our objective was to determine whether maltreated children have an elevated number of NDDs and whether CM is a risk factor for an increased NDD 'load' and increased NDD symptoms when controlling for familial effects. METHODS: We used a cross-sectional sample from a population-representative Swedish twin study, comprising 8,192 nine-year-old twins born in Sweden between 1997 and 2005. CM was defined as parent-reported exposure to emotional abuse/neglect, physical neglect, physical abuse, and/or sexual abuse. Four NDDs were measured with the Autism-Tics, AD/HD, and other comorbidities inventory. RESULTS: Maltreated children had a greater mean number of NDDs than nonmaltreated children. In a co-twin control design, CM-discordant monozygotic twins did not differ significantly for their number of NDDs, suggesting that CM is not associated with an increased load of NDDs when genetic and shared environmental factors are taken into account. However, CM was associated with a small increase in symptoms of attention-deficit/hyperactivity disorder and autism spectrum disorder in CM-discordant MZ twins, although most of the covariance of CM with NDD symptoms was explained by common genetic effects. CONCLUSIONS: Maltreated children are at higher risk of having multiple NDDs. Our findings are, however, not consistent with the notion that CM causes the increased NDD load in maltreated children. Maltreated children should receive a full neurodevelopmental assessment, and clinicians should be aware that children with multiple NDDs are at higher risk of maltreatment.
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| 9. |
- Dinkler, Lisa
(författare)
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Restrictive eating disorders: aetiological, epidemiological and neurodevelopmental aspects
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Restrictive Eating Disorders (EDs), including Avoidant/Restrictive Food Intake Disorder (ARFID) and Anorexia Nervosa (AN), are characterised by severely restricted food intake, commonly leading to substantial weight loss and significantly low weight, and the need for nutritional supplementation. The overarching aim of this thesis was to elucidate specific aetiological, epidemiological, and neurodevelopmental aspects of ARFID and AN, including the genetic aetiology of AN, the link between AN and autism spectrum disorder (ASD), the prevalence of ARFID, and the comorbidity of ARFID with neurodevelopmental disorders (NDDs). Studies I and II were based on the Child and Adolescent Twin Study in Sweden, making use of parent- and/or child-reported survey data and clinical diagnoses from the Swedish National Patient Register. Using twin modelling, Study I examined whether adolescent-onset EDs (excluding ARFID) can be viewed aetiologically as the extreme manifestation of continuous variation in ED traits in the population (e.g., drive for thinness). Genetic factors influencing continuous variation of ED traits were less associated with AN than with other EDs, suggesting that EDs other than AN are on an aetiological continuum with ED traits, while AN is more genetically demarcated. Considering the previously observed overrepresentation of autistic traits in individuals with AN, Study II prospectively examined whether autistic traits in AN are already present in childhood. Individuals later diagnosed with AN did not show elevated autistic traits at age 9. At age 18, autistic traits were elevated in girls with acute AN, but not in girls with a history of AN. Potential elevations of autistic traits in childhood might have been concealed by coping strategies and the different/less overt female ASD phenotype. Using a novel experimental design, Study III examined the ability and strategy to recognise facial emotional expressions—often impaired in ASD—in women recovered from AN who were part of the 30-year follow-up in a Swedish case-control study. Women recovered from AN without ASD did not have deficits in emotion recognition, suggesting that impairments might be limited to the acute AN phase and/or the ASD subgroup. Studies IV and V were based on a parent-reported screening tool for ARFID developed by our group, applied in a sub-cohort of 4-7-year-old children from the Japan Environment and Children's Study. Study IV aimed to estimate the prevalence of ARFID and found a point prevalence of ~1%. ARFID was equally common in boys and girls. Using ICD-11 diagnostic criteria resulted in a higher prevalence than using DSM-5 criteria. Taking advantage of additional parent-reported data, Study V found that children with ARFID had an elevated risk of a broadly atypical/delayed neurodevelopment and a 3-4 times increased likelihood of being diagnosed with NDDs. In summary, this thesis showed that AN might have a different aetiology than other adolescent-onset EDs, and that prospective studies are important to help disentangle the relationship between AN and ASD. Contrary to AN, ARFID is associated with increased risk for a range of neurodevelopmental problems/NDDs. Future studies should investigate whether ARFID in young children might be more strongly associated with NDDs than with later-onset EDs.
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| 10. |
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