Southlake Psychiatric & Counseling Center

Gut Biomarkers Accurately Flag Autism Spectrum Disorder
Publish date: July 10, 2024
By Megan Brooks

FROM NATURE MICROBIOLOGY

Bacterial and nonbacterial components of the gut microbiome and their function can accurately differentiate children with autism spectrum disorder (ASD) from neurotypical children, new research shows.

The findings could form the basis for development of a noninvasive diagnostic test for ASD and also provide novel therapeutic targets, wrote investigators, led by Siew C. Ng, MBBS, PhD, with the Microbiota I-Center (MagIC), the Chinese University of Hong Kong.

Their study was published online in Nature Microbiology.

Beyond Bacteria

The gut microbiome has been shown to play a central role in modulating the gut-brain axis, potentially influencing the development of ASD.

However, most studies in ASD have focused on the bacterial component of the microbiome. Whether nonbacterial microorganisms (such as gut archaea, fungi, and viruses) or function of the gut microbiome are altered in ASD remains unclear.

To investigate, the researchers performed metagenomic sequencing on f***l samples from 1627 boys and girls aged 1-13 years with and without ASD from five cohorts in China.

After controlling for diet, medication, and comorbidity, they identified 14 archaea, 51 bacteria, 7 fungi, 18 viruses, 27 microbial genes, and 12 metabolic pathways that were altered in children with ASD.

Machine-learning models using single-kingdom panels (archaea, bacteria, fungi, viruses) achieved area under the curve (AUC) values ranging from 0.68 to 0.87 in differentiating children with ASD from neurotypical control children.

A model based on a panel of 31 multikingdom and functional markers achieved “high predictive value” for ASD, achieving an AUC of 0.91, with comparable performance among boys and girls.

“The reproducible performance of the models across ages, s*xes, and cohorts highlights their potential as promising diagnostic tools for ASD,” the investigators wrote.

They also noted that the accuracy of the model was largely driven by the biosynthesis pathways of ubiquinol-7 and thiamine diphosphate, which were less abundant in children with ASD, and may serve as therapeutic targets.

‘Exciting’ Possibilities
“This study broadens our understanding by including fungi, archaea, and viruses, where previous studies have largely focused on the role of gut bacteria in autism,” Bhismadev Chakrabarti, PhD, research director of the Centre for Autism at the University of Reading, United Kingdom, said in a statement from the nonprofit UK Science Media Centre.

“The results are broadly in line with previous studies that show reduced microbial diversity in autistic individuals. It also examines one of the largest samples seen in a study like this, which further strengthens the results,” Dr. Chakrabarti added.

He said this research may provide “new ways of detecting autism, if microbial markers turn out to strengthen the ability of genetic and behavioral tests to detect autism. A future platform that can combine genetic, microbial, and simple behavioral assessments could help address the detection gap.

“One limitation of this data is that it cannot assess any causal role for the microbiota in the development of autism,” Dr. Chakrabarti noted.

This study was supported by InnoHK, the Government of Hong Kong, Special Administrative Region of the People’s Republic of China, The D. H. Chen Foundation, and the New Cornerstone Science Foundation through the New Cornerstone Investigator Program. Dr. Ng has served as an advisory board member for Pfizer, Ferring, Janssen, and AbbVie; has received honoraria as a speaker for Ferring, Tillotts, Menarini, Janssen, AbbVie, and Takeda; is a scientific cofounder and shareholder of GenieBiome; receives patent royalties through her affiliated institutions; and is named as a co-inventor of patent applications that cover the therapeutic and diagnostic use of microbiome. Dr. Chakrabarti has no relevant conflicts of interest.

SILENCE YOUR INNER CRITIC
The criticism coming from your inner voice is often far from constructive. In fact, it tends to be downright demeaning and listening to it does you no good at all. But psychologists are working on ways to help you brush off the bruising remarks and help you crawl out from under your negative self talk
I am lazy. I’m a slob. I’m [something that can’t be printed]. These are the thoughts that pop into my head when I’m senselessly scrolling on the sofa, or after I’ve found another bag of withered salad in the fridge (forgotten in favour of the takeaways I chose to have instead of preparing my own, healthier options). I’m gross. I’m unhealthy. I’m a stupid, ugly [expletive].
You’re probably all these things too – at least according to your inner critic. That demeaning and derogatory little voice in your head is so universal that it’s been widely represented in pop culture, from Radiohead’s ‘Creep’ and TLC’s ‘Unpretty’ to Rick Dalton (as played by Leonardo DiCaprio) in Once Upon a Time in Hollywood. “What the f— was that?!” Dalton rages after forgetting his lines on set. “Embarrassed yourself like that in front of all those goddamn people!” He is, he decides, a baboon.
But why do so many of us have these negative thoughts? It’s tempting to think that the things our inner critics say have value – after all, I really do have too many takeaways and I really should do something more productive than endlessly scrolling through social media on my sofa. So should we try to silence the voice that demeans us? And if so, how can we actually do that? Before we can answer those questions, however, we have to ask another: how is it that we evolved to bully ourselves in the first place?
“In most social hierarchies, and when animals work in groups, they have to have a way of regulating their competitive behaviour with each other,” says Paul Gilbert, a professor of clinical psychology at the University of Derby in the UK whose research on self-criticism encompasses both neuroscience and evolutionary psychology. Gilbert says that for these hierarchies to work, “our brains are designed to submit when we’re under attack from a dominant other.”
Social attacks can feel similar to physical attacks because we have evolved to seek status – in hunter-gatherer societies, it had to be apparent what we could bring to the group. According to Gilbert, when people don’t live up to these expectations and become self-critical, they stimulate the same areas of the brain that fire up when we’re under attack from others – the anterior cingulate cortex and the amygdala, the brain’s threat system. For this reason, Gilbert prefers to describe self-criticism as “self-attacking”.

THE SHAME GAME
Of course, despite our shared evolutionary history, some of us think more negatively about ourselves than others. Daniel Kopala-Sibley is a psychology professor at Canada’s University of Calgary who researches the role of developmental experiences on mental health. Kopala-Sibley has found that people with self-critical personality styles have often experienced shaming, expectations of high performance and excessive criticism from others in childhood.
“Experiences of one’s parents being critical, uncaring, controlling or maltreating are robustly associated with high levels of self-criticism [in] adulthood,” Kopala-Sibley says. His research has also found that young adults who recall being bullied or excluded are also more self-critical.
When negative self-talk is so ingrained, it can be hard to convince people that it’s a bad thing – Gilbert has found that people can even fear losing their demeaning inner voice. “Some people say self-criticism is really trying to help you,” he says. “No, it’s not.”
While reflecting on your mistakes isn’t a problem, Gilbert says, it’s the “hostility” of self-criticism that does the damage. He explains that just as your body releases hormones when your mind drifts to s*xual thoughts, it also responds physically to self-critical thoughts, with spikes in the stress hormone cortisol, which can lead to health problems.
What’s more, researchers have now repeatedly demonstrated that self-criticism can be fantastically unhelpful. In 1992, academics at the University of Montreal asked 46 students to play darts. Students who were asked to repeat ‘positive verbalisations’ between throws improved faster than a control group who simply rested between throws. Students who were asked to repeat ‘negative verbalisations’ performed the worst of all.
Further studies have replicated these findings and in 2013, Japanese sports psychologists found that swimmers who engaged in positive self-talk swam significantly faster than those who didn’t.
So is that the solution? Run a bubble bath, relax into an evening of self-care and tell yourself you’re fabulous? Actually, it’s a little more complicated (and more scientific) than that.

SHOW SOME COMPASSION
Gilbert has developed techniques known as compassion-focused therapy and compassionate mind training (CMT), psychotherapeutic approaches that help people develop self-compassion. “The first thing is recognising the harm you’re doing to yourself as a person,” he says.
Gilbert works with patients to help them understand the origins of their critical voice – are they really speaking to themselves, or are they hearing the echo of an abusive parent? By examining exactly what the self-critical voice is saying, Gilbert will also help patients understand that it’s not trying to be helpful. “It’s not asking you, ‘What’s the problem? Why are you struggling?’,” he says. “It’s very hostile: ‘Why are you so stupid? What’s wrong with you? You’re just lazy!’”
This is where the compassion comes in. Gilbert helps patients practise compassionate voice tones – you could start off by imagining that you’re supporting a friend who is struggling with the same frustrations that you are. Using brain scans captured via functional magnetic resonance imaging in 2010, Gilbert and his peers were able to find that self-reassurance was associated with the same areas of the brain as being compassionate to others.
“So, you know how to be compassionate,” Gilbert tells his patients, “What is it that stops you from using those same ways of dealing with disappointment on yourself?” If that seems like a hard place to start, psychologists at the University of California have found that being compassionate to others can actually increase our self-compassion – they called it “activating the inner caregiver”.
Another CMT exercise involves unmasking the critical voice – Gilbert compares it to pulling back the curtain on the Wizard of Oz and finding an ordinary man. “You imagine the critic in front of you and then get round the back of the critic to see what they’re really worried about,” he says, arguing that most self-criticism is based on an underlying fear, be it of rejection or failure. Gilbert says that once people identify that underlying fear, they can become more compassionate about it.
The psychologist also believes that we must use our bodies to support our minds. Breathing techniques can help stimulate the vagus nerve, a part of our parasympathetic nervous system that can calm us down by slowing our heart rate and neutralising our fight-or-flight response.
“People who are very self-critical are often not so good at stimulating the vagus,” Gilbert says. He advises breathing with your diaphragm – inhaling for five seconds and resting for two seconds, before breathing out for five seconds.
Just as self-criticism has physiological effects, so does self-compassion. One 2021 study by neuropsychologists at the University of Coimbra in Portugal found that two weeks of CMT exercises improved people’s heart rate variability, which is associated with resilience to stress. That same year, a meta-analysis of 20 self-compassion studies also found that these interventions produced a significant reduction in self-criticism.
Self-compassion has even been found to help us in the same way that we assume self-criticism does – in 2012, psychologists at the University of California discovered that being accepting of yourself after making a mistake increases motivation.

GIVE IT A NAME
Self-compassion isn’t the only antidote to self-criticism – alternative schools of thought are also emerging. Prof Golan Shahar is a clinical health psychologist and author of Erosion: The Psychopathology of Self-Criticism. He believes that curiosity is key.
“If [you’re] really self-critical, why would you allow a compassionate voice to diffuse your self-criticism?” he asks. Instead, Shahar believes self-criticism is motivated by a desire for self-knowledge.
“Understanding ourselves and the world is paramount for us in order to survive. It’s an evolutionary dictum,” he says, “So the other school [of thought] that I'm trying to advance as an alternative to self-compassion is curiosity.”
Shahar believes that we need to understand our self-critical voice in order to undermine it – “understanding like in espionage, where you understand the enemy”. Trying to understand it, Shahar says, “invokes curiosity – and by invoking curiosity, you distance yourself from the voice and start to observe how it essentially ruins your life from afar.”
Shahar has developed an intervention known as ‘multiple-selves analysis’, which he has been practising with his patients, although it hasn’t yet undergone clinical trials. This method involves characterising your inner bully – firstly, by coming up with a name for it (some people choose the name of an ex-partner). Shahar encourages people to recall their first encounter with the voice and assign it a colour and sound, usually a type of music they associate with the way the voice talks (often, this is heavy metal).
Shahar colours in one segment of a pie chart to represent the voice and to demonstrate to patients that the self-critic is only one aspect of their inner world. He then uses the same techniques to help people find other, non-critical voices within themselves – firstly, by coming up with another element of their personality, for example their love of fun, before similarly assigning that voice a name, colour and sound.
“We repeat the cycle and we come up with five voices,” Shahar says. Everyday, patients are then asked to enlarge or decrease the size of the coloured segments to record which voice is more dominant. “So people really see what is affected when the self-critical voice is increased,” Shahar explains. Gradually, patients discover that their self-critical voices aren’t consistent with the voice’s professed goals – I don’t actually get off the sofa and prepare a salad after being berated.
Shahar stresses that his method is not a one-size-fits-all cure for self-criticism, but is simply one intervention that’s part of a wider journey. Other researchers have, however, demonstrated the efficacy of similar tasks.

EXPRESS YOURSELF
In 2012, psychologists at the University of Hertfordshire split 46 people into two groups, asking the first group to write about their life goals and the second to review a film or book. In a two-week follow-up, they found that participants who wrote about their goals had reduced levels of self-criticism, although those who used prescriptive words such as “could”, “would” and “should” were least likely to have experienced a decrease. Based on this, it seems, expressive writing can help us to reassure ourselves and, in practice, that writing could be a simple diary entry.
The ‘two-chair technique’ is another method for diminishing your critical voice. Patients move between two chairs to encourage a dialogue between two aspects of their selves – in the critic’s chair, the harsh inner voice speaks freely before the patient switches to the other chair and expresses how it feels to be criticised. In this chair, patients may grow angrier and more assertive towards the critic, while the critic may become more compassionate as it hears from a voice pleading, “Stop attacking me.” Studies have found that this technique effectively reduces self-criticism as well as depression and anxiety symptoms, while simultaneously increasing self-compassion and self-reassurance.
Still, we can’t just look for magic bullets. David Zuroff is a psychology professor at McGill University in Canada, and an expert in self-criticism. He notes that a temporary “state” of self-criticism is not necessarily maladaptive, but that things become problematic when it’s a habitual “trait”. Similarly, so-called behavioural self-criticism – “Why did I do that stupid thing?” – is less troubling than “global” self-criticism, whereby people degrade their entire selfhood.
“I believe that brief laboratory or internet interventions are unlikely to produce lasting change in self-criticism,” Zuroff says. He argues instead that “any of several forms of psychotherapy is likely to be more beneficial for the severely self-critical”.
And – no matter what the voice in your head says – this is an issue worth tackling. Zuroff’s longitudinal studies have found that high levels of self-criticism in people aged 12 predicted dissatisfaction and maladjustment by the time they’d reached 31 years of age. “You can hardly name a human problem that hasn’t been empirically linked with high levels of self-criticism,” he says – giving examples from depression to gambling addiction.
In short, Zuroff says, when it comes to berating and bullying yourself, “It would be a good thing for people who do it a lot to do it less.”

Research Letter Adolescent Mental Health
June 3, 2024
Weight Indices, Cognition, and Mental Health From Childhood to Early Adolescence
Zhaolong Adrian Li, BA1; Mary Katherine Ray, PhD1; Yueping Gu, HS2; et al Deanna M. Barch, PhD2; Tamara Hershey, PhD1
Author Affiliations Article Information
JAMA Pediatr. Published online June 3, 2024. doi:10.1001/jamapediatrics.2024.1379
High child and adolescent obesity rates (eg, 19.7% in the US) are problematic given links between early-life obesity and long-term health issues.1 While evidence suggests cross-sectional associations between obesity, lower cognitive functioning, and worse mental health in youth,2 it remains unclear whether these findings extend longitudinally and in what direction. Leveraging data from the Adolescent Brain Cognitive Development (ABCD) Study (release 5.0),3,4 we examined how weight indices for children aged 9 to 11 years are associated with changes in cognition and psychopathology across the 2 years thereafter, and vice versa.

Methods
Baseline (June 2016 to October 2018) and 1- and 2-year follow-up ABCD Study data collected before COVID-19 (March 13, 2020) were included in this cohort study. Weight indices (body mass index [BMI]; waist circumference [WC]) and psychopathology were assessed annually3; cognition was assessed at baseline and 2 years4 (Table). Caregiver-reported race was assessed for reporting reasons. Caregivers and children provided written informed consent or assent to procedures approved by site institutional review boards. We followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines.

We used [age] × [baseline variable] interactions in linear mixed models to estimate associations between baseline BMI or WC and changes in cognition or psychopathology across time points, and vice versa. Models also included lower-order main effects, sociodemographic and developmental covariates, nested random intercepts, and random slopes (Figure). Sensitivity analyses explored (1) s*x differences; (2) non-Gaussian distributions; and confounding of (3) weight-related medication (eg, psychostimulants) use, (4) common baseline psychiatric diagnoses, and (5) psychopathology covariates in baseline cognition models. We also ruled out any confounds from practice effects on the cognitive tasks. Significance was set at 2-sided P value of .05 corrected for false discovery rate (FDR). Data were analyzed from August 2023 to March 2024 using R software version 4.3.1 (R Project for Statistical Computing) (eMethods in Supplement 1).

Results
Characteristics of 5269 participants are shown in Table. Baseline BMI was not associated with longitudinal changes in cognition (Figure). Conversely, lower baseline cognition was overall associated with greater longitudinal BMI gain, including after adjusting for baseline psychopathology. In unstandardized estimates, for example, children who scored 1 point lower on baseline picture vocabulary had 0.012 (1.6%) more annual BMI (calculated as weight in kilograms divided by height in meters squared) gain than those scoring at median (IQR) of 85 (10).

Higher baseline BMI was associated with more longitudinal withdrawn or depressed symptoms and depression problems (Figure), with each 1 increase corresponding to 0.010 (22%) and 0.011 (15%) more problems annually beyond changes at median BMI. In equivalent clinical estimates, children with overweight or obesity (BMI ≥85th percentile) at baseline gained 0.07 (172%) and 0.06 (93%) more problems annually than those with normal weight (BMI ≥5th to

JAMA Pediatrics Patient Page
June 24, 2024
What Parents Need to Know About Autism Screening and Early Treatment
Vijay Vasudevan, PhD, MPH1; Anne Nagel, PhD1; Lindsay A. Thompson, MD, MS2
Author Affiliations Article Information
JAMA Pediatr. Published online June 24, 2024. doi:10.1001/jamapediatrics.2024.1324

As a parent, it is normal to wonder how your child will grow and develop.

Importantly, your child will grow at their own pace. By knowing and understanding how they play, learn, and behave, you, with your pediatrician, can help your child. As they get older, it is important to keep track of skills that they are and are not able to do. The Centers for Disease Control and Prevention has a list of what to keep track of as your child grows.

There is a broad range of normal as your child develops. Areas to consider include communication, gross motor (like walking), fine motor (like handwriting), social, and problem-solving skills. Focusing on social and communication skills, it is important to notice if they are falling behind or seem different from children their age. You know your child. Autism is a developmental disability that may affect a child’s ability to communicate, their behavior, and their social skills. The 3 most common things to look out for if you think your child might have autism are (1) lack of attention skills, (2) language delays and differences, and (3) regression of skills.

Pediatricians usually screen for autism at a child’s 18-month and 24-month checkups, or whenever you or others have concerns with how your child is growing. A child can be diagnosed with autism at any age. Research has shown that the sooner you get your child into an early treatment program, the better your child may do in school and in other aspects of their life. A diagnosis of autism helps teachers and parents create individual ways to help the child learn and interact with peers.

If you or your child’s pediatrician thinks your child might be behind in their development, either of you can refer your child to therapies like physical, occupational, or speech therapy. Your child does not need to have an autism diagnosis to receive these therapies. If your child is younger than 3 years, these therapies could be free or have reduced cost. Every state has an early intervention program, and they can screen your child to see if they are eligible. If your child can get these services, a team of professionals will work with you to develop a plan to help your child. If your child is 3 years or older, your local public elementary school can provide these services, even if your child does not go to the school. You should call the school and ask to have your child evaluated through the school system for preschool special education services. If the person who answers is not aware of preschool special education, you can ask to talk to the school or district special education director. Sometimes, families might have to wait weeks or months for treatments, but the treatments will help your child grow and learn. Be patient because it will help your child. Talk to your health care professional about care you can provide for your child for free as you wait for an autism evaluation and treatment plan.

For More Information

Centers for Disease Control and Prevention
https://www.cdc.gov/ncbddd/actearly/milestones/index.html

HealthyChildren.org
https://www.healthychildren.org/English/health-issues/conditions/Autism/Pages/Early-Signs-of-Autism-Spectrum-Disorders.aspx

Centers for Disease Control and Prevention
https://www.cdc.gov/ncbddd/actearly/parents/states.html

Autism Speaks
https://www.autismspeaks.org/cst-information-parents-and-caregivers

The JAMA Pediatrics Patient Page is a public service of JAMA Pediatrics. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your child’s medical condition, JAMA Pediatrics suggests that you consult your child’s physician. This page may be downloaded or photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, email [email protected].
Back to top Article Information
Published Online: June 24, 2024. doi:10.1001/jamapediatrics.2024.1324

Your source for the latest research news

Internet addiction affects the behavior and development of adolescents


Date: Source: Summary:

June 4, 2024
University College London
Adolescents with an internet addiction undergo changes in the brain that could lead to additional addictive behavior and tendencies, finds a new study.


FULL STORY

Adolescents with an internet addiction undergo changes in the brain that could lead to additional addictive behaviour and tendencies, finds a new study by UCL researchers.
The findings, published in PLOS Mental Health, reviewed 12 articles involving 237 young people aged 10-19 with a formal diagnosis of internet addiction between 2013 and 2023.
Internet addiction has been defined as a person's inability to resist the urge to use the internet, negatively impacting their psychological wellbeing, as well as their social, academic and profes‐ sional lives.
The studies used functional magnetic resonance imaging (fMRI) to inspect the functional con‐ nectivity (how regions of the brain interact with each other) of participants with internet addic‐ tion, both while resting and completing a task.
The effects of internet addiction were seen throughout multiple neural networks in the brains of adolescents. There was a mixture of increased and decreased activity in the parts of the brain that are activated when resting (the default mode network).
Meanwhile, there was an overall decrease in the functional connectivity in the parts of the brain involved in active thinking (the executive control network).
These changes were found to lead to addictive behaviours and tendencies in adolescents, as well as behaviour changes associated with intellectual ability, physical coordination, mental health and development.

Lead author, MSc student, Max Chang (UCL Great Ormond Street Institute for Child Health) said: "Adolescence is a crucial developmental stage during which people go through significant changes in their biology, cognition, and personalities. As a result, the brain is particularly vulner‐ able to internet addiction related urges during this time, such as compulsive internet usage, cravings towards usage of the mouse or keyboard and consuming media.
"The findings from our study show that this can lead to potentially negative behavioural and de‐ velopmental changes that could impact the lives of adolescents. For example, they may struggle to maintain relationships and social activities, lie about online activity and experience irregular eating and disrupted sleep."
With smartphones and laptops being ever more accessible, internet addiction is a growing prob‐ lem across the globe. Previous research has shown that people in the UK spend over 24 hours every week online and, of those surveyed, more than half self-reported being addicted to the internet.
Meanwhile, Ofcom found that of the 50 million internet users in the UK, over 60% said their in‐ ternet usage had a negative effect on their lives -- such as being late or neglecting chores.
Senior author, Irene Lee (UCL Great Ormond Street Institute of Child Health), said: "There is no doubt that the internet has certain advantages. However, when it begins to affect our day-to-day lives, it is a problem.
"We would advise that young people enforce sensible time limits for their daily internet usage and ensure that they are aware of the psychological and social implications of spending too much time online."
Mr Chang added: "We hope our findings will demonstrate how internet addiction alters the con‐ nection between the brain networks in adolescence, allowing physicians to screen and treat the onset of internet addiction more effectively.
"Clinicians could potentially prescribe treatment to aim at certain brain regions or suggest psy‐ chotherapy or family therapy targeting key symptoms of internet addiction.
"Importantly, parental education on internet addiction is another possible avenue of prevention from a public health standpoint. Parents who are aware of the early signs and onset of internet addiction will more effectively handle screen time, impulsivity, and minimise the risk factors sur‐ rounding internet addiction."
Study limitations
Research into the use of fMRI scans to investigate internet addiction is currently limited and the studies had small adolescent samples. They were also primarily from Asian countries. Future research studies should compare results from Western samples to provide more insight on ther‐ apeutic intervention.


Story Source:
Materials provided by University College London. Note: Content may be edited for style and length.

Journal Reference:
1. Max L. Y. Chang, Irene O. Lee. Functional connectivity changes in the brain of adoles‐ cents with internet addiction: A systematic literature review of imaging studies. PLOS Mental Health, 2024; 1 (1): e0000022 DOI: 10.1371/journal.pmen.0000022