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Cited by 55Cardiovascular Syncope and Autonomic DisordersAutism Spectrum Disorder ResearchHeart Rate Variability and Autonomic Control

Autonomic Dysfunction in Autism Spectrum Disorder

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Owens, Andrew P., Mathias, Christopher J., Iodice, Valeria·2021·Frontiers in Integrative Neuroscience
DOI 10.3389/fnint.2021.787037PMC PMC8756818
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Abstract

Background: There have been previous reports of enhanced sympathoexcitation in autism spectrum disorder (ASD). However, there has been no formal investigation of autonomic dysfunction in ASD. Also, the joint hypermobile form of Ehlers-Danlos syndrome (hE-DS) that maybe overrepresented in ASD and orthostatic related autonomic dysfunction. This study examined the comorbidity of ASD, autonomic dysfunction and hE-DS in two UK autonomic national referral centers. Proven, documented and globally accepted clinical autonomic investigations were used to assess neuro-cardiovascular autonomic function in a cohort of ASD subjects and in age-matched healthy controls. Methods: Clinical data from 28 referrals with a confirmed diagnosis of ASD over a 10-year period were compared with 19 age-matched healthy controls. Autonomic function was determined using methods established in the centers previously described in detail. Results: 20/28 ASD had a diagnosed autonomic condition; 9 had the postural tachycardia syndrome (PoTS), 4 PoTS and vasovagal syncope (VVS), 3 experienced presyncope, 1 essential hyperhidrosis, 1 orthostatic hypotension, 1 VVS alone and 1 a combination of PoTS, VVS and essential hyperhidrosis. 16/20 ASD with autonomic dysfunction had hE-DS. In ASD, basal heart rate and responses to orthostatic tests of autonomic function were elevated, supporting previous findings of increased sympathoexcitation. However, sympathetic vasoconstriction was impaired in ASD. Conclusion: Intermittent neuro-cardiovascular autonomic dysfunction affecting heart rate and blood pressure was over-represented in ASD. There is a strong association with hE-DS. Autonomic dysfunction may further impair quality of life in ASD, particularly in those unable to adequately express their experience of autonomic symptoms.

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References 45 · Cited by 55

Research works printed but not linked: 32

  1. Althaus M. Van Roon A. M. Mulder L. J. Mulder G. Aarnoudse C. C. Minderaa R. B. (2004). Autonomic response patterns observed during the performance of an attention-demanding task in two groups of children with autistic-type difficulties in social adjustment. Psychophysiology 41 893– 904. 10.1111/j.1469-8986.2004.00252.x 15563342 · DOI
  2. Aman M. G. (2004). Management of hyperactivity and other acting-out problems in patients with autism spectrum disorder. Semin. Pediatric Neurol. 11 225– 228. 10.1016/j.spen.2004.07.006 15575418 · DOI
  3. Anderson C. J. Colombo J. Unruh K. E. (2013). Pupil and salivary indicators of autonomic dysfunction in autism spectrum disorder. Dev. Psychobiol. 55 465– 482. 10.1002/dev.21051 22644965 PMC3832142 · DOI
  4. Bannister R. Mathias C. J. (2013). “ Introduction and classification of autonomic disorders,” in Autonomic Failure, eds Mathias C. J. Bannister R. (Oxford: Oxford University Press), 3– 9. 10.1093/med/9780198566342.003.0001 · DOI
  5. Benarroch E. E. (2012). Postural tachycardia syndrome: a heterogeneous and multifactorial disorder. Mayo Clin. Proc. 87 1214– 1225. 10.1016/j.mayocp.2012.08.013 23122672 PMC3547546 · DOI · Paper page
  6. Bernhardt B. C. Di Martino A. Valk S. L. Wallace G. L. (2016). Neuroimaging-based phenotyping of the autism spectrum. Curr. Top. Behav. Neurosci. 30 341– 355. 10.1007/7854_2016_438 26946501 · DOI
  7. Boddaert N. Chabane N. Gervais H. Good C. D. Bourgeois M. Plumet M. H. (2004). Superior temporal sulcus anatomical abnormalities in childhood autism: A voxel-based morphometry MRI study. NeuroImage 23 364– 369. 10.1016/j.neuroimage.2004.06.016 15325384 · DOI · Paper page
  8. Dalton K. M. Kalin N. H. Grist T. M. Davidson R. J. (2005). Neural-cardiac coupling in threat-evoked anxiety. J. Cogn. Neurosci. 17 969– 980. 10.1162/0898929054021094 15969913 · DOI
  9. Duerden E. G. Taylor M. J. Soorya L. V. Wang T. Fan J. Anagnostou E. (2013). Neural correlates of inhibition of socially relevant stimuli in adults with autism spectrum disorder. Brain Res. 1533 80– 90. 10.1016/j.brainres.2013.08.021 23962468 · DOI
  10. Ebisch S. J. H. Gallese V. Willems R. M. Mantini D. Groen W. B. Romani G. L. (2011). Altered intrinsic functional connectivity of anterior and posterior insula regions in high-functioning participants with autism spectrum disorder. Human Brain Map. 32 1013– 1028. 10.1002/hbm.21085 20645311 PMC6870194 · DOI
  11. Eccles J. A. Owens A. P. Mathias C. J. Umeda S. Critchley H. D. (2015). Neurovisceral phenotypes in the expression of psychiatric symptoms. Front. Neurosci. 9: 4. 10.3389/fnins.2015.00004 25713509 PMC4322642 · DOI
  12. Evrard H. C. (2019). The organization of the primate insular cortex. Front. Neuroanat. 13: 43. 10.3389/fnana.2019.00043 31133822 PMC6517547 · DOI
  13. Hadjikhani N. Joseph R. M. Manoach D. S. Naik P. Snyder J. Dominick K. (2009). Body expressions of emotion do not trigger fear contagion in autism spectrum disorder. Soc. Cogn. Affect. Neurosci. 4 70– 78. 10.1093/scan/nsn038 19151375 PMC2656879 · DOI
  14. Hutt C. Hutt S. J. Lee D. Ounsted C. (1964). Arousal and childhood autism. Nature 204: 908. 10.1038/204908a0 14235732 · DOI
  15. Jänig W. Häbler H. J. (2003). Neurophysiological analysis of target-related sympathetic pathways - From animal to human: Similarities and differences. Acta Physiol. Scand. 177 255– 274. 10.1046/j.1365-201X.2003.01088.x 12608996 · DOI
  16. Kaufmann H. Saadia D. Polin C. Hague S. Singleton A. Singleton A. (2003). Primary hyperhidrosis: Evidence for autosomal dominant inheritance. Clin. Auton. Res. 13 96– 98. 10.1007/s10286-003-0082-x 12720093 · DOI
  17. Lai F. C. Tu Y. R. Li Y. P. Li X. Lin M. Chen J. F. (2015). Nation wide epidemiological survey of primary palmar hyperhidrosis in the People’s Republic of China. Clin. Auton. Res. 25 105– 108. 10.1007/s10286-014-0259-5 25381140 · DOI
  18. Martineau J. Hernandez N. Hiebel L. Roche L. Metzger A. Bonnet-Brilhault F. (2011). Can pupil size and pupil responses during visual scanning contribute to the diagnosis of autism spectrum disorder in children? J. Psychiatric Res. 45 1077– 1082. 10.1016/j.jpsychires.2011.01.008 21679969 · DOI
  19. Mathias C. J. Deguchi K. Bleasdale-Barr K. Kimber J. R. (1998). Frequency of family history in vasovagal syncope. Lancet 352 33– 34. 10.1016/S0140-6736(05)79513-1 9800748 · DOI
  20. Mathias C. J. Low D. A. Iodice V. Bannister R. (2013). “ Investigation of autonomic disorders,” in Autonomic Failure, eds Mathias C. J. Bannister R. (Oxford: Oxford University Press), 258– 287. 10.1093/med/9780198566342.003.0024 · DOI
  21. Ming X. Bain J. M. Smith D. Brimacombe M. (2011). Gold von-Simson G, Axelrod FB. Assessing autonomic dysfunction symptoms in children: A pilot study. J. Child Neurol. 26 420– 427. 10.1177/0883073810381921 21196528 · DOI
  22. Moraites E. Vaughn O. A. Hill S. (2014). Incidence and prevalence of hyperhidrosis. Dermatol. Clin. 32 457– 465. 10.1016/j.det.2014.06.006 25152338 · DOI
  23. Ocon A. J. Medow M. S. Taneja I. Clarke D. Stewart J. M. (2009). Decreased upright cerebral blood flow and cerebral autoregulation in normocapnic postural tachycardia syndrome. Am. J. Physiol. Heart Circul. Physiol. 297 H664– H673. 10.1152/ajpheart.00138.2009 19502561 PMC2724195 · DOI · Paper page
  24. Owens A. P. Low D. A. Iodice V. Mathias C. J. Critchley H. D. (2016). Emotion and the autonomic nervous system-a two-way street: Insights from affective, autonomic and dissociative disorders. Curat. Ref. Collec. Neurosci. Biobehav. Psychol. 2016: 1779. 10.1016/B978-0-12-809324-5.01799-5 · DOI
  25. Porges S. W. Doussard-Roosevelt J. A. Portales A. L. Greenspan S. I. (1996). Infant regulation of the vagal “brake” predicts child behavior problems: a psychobiological model of social behavior. Dev. Psychobiol. 29 69 7– 712. 10.1002/(SICI)1098-2302(199612)29:8<697::AID-DEV5>3.0.CO;2-O 8958482 · DOI
  26. Porges S. W. Macellaio M. Stanfill S. D. McCue K. Lewis G. F. Harden E. R. (2013). Respiratory sinus arrhythmia and auditory processing in autism: Modifiable deficits of an integrated social engagement system? Int. J. Psychophysiol. 88 261– 270. 10.1016/j.ijpsycho.2012.11.009 23201146 PMC3610863 · DOI · Paper page
  27. Quattrocki E. Friston K. (2014). Autism, oxytocin and interoception. Neurosci. Biobehav. Rev. 47 410– 430. 10.1016/j.neubiorev.2014.09.012 25277283 PMC4726659 · DOI · Paper page
  28. Sandroni P. Novak V. Opfer-Gehrking T. L. Huck C. A. Low P. A. (2000). Mechanisms of blood pressure alterations in response to the Valsalva maneuver in postural tachycardia syndrome. Clin. Auton. Res. 10 1– 5. 10.1007/BF02291382 10750636 · DOI · Paper page
  29. Seeley W. W. Merkle F. T. Gaus S. E. Craig A. D. Allman J. M. Hof P. R. (2012). Distinctive neurons of the anterior cingulate and frontoinsular cortex: A historical perspective. Cereb. Cortex 22 245– 250. 10.1093/cercor/bhr005 21653703 · DOI
  30. Simms M. L. Kemper T. L. Timbie C. M. Bauman M. L. Blatt G. J. (2009). The anterior cingulate cortex in autism: heterogeneity of qualitative and quantitative cytoarchitectonic features suggests possible subgroups. Acta Neuropathol. 118 673– 684. 10.1007/s00401-009-0568-2 19590881 · DOI · Paper page
  31. Toichi M. Kamio Y. (2003). Paradoxical autonomic response to mental tasks in autism. J. Autism Dev. Disord. 33 417– 426. 10.1023/A:1025062812374 12959420 · DOI · Paper page
  32. Watanabe T. Yahata N. Abe O. Kuwabara H. Inoue H. Takano Y. (2012). Diminished medial prefrontal activity behind autistic social judgments of incongruent information. PLoS One 7: e39561. 10.1371/journal.pone.0039561 22745788 PMC3382122 · DOI

Authors
Owens, A. P., Mathias, C. J., & Iodice, V.
Affiliations
  • King's College London (GB)
  • University College London Hospitals NHS Foundation Trust (GB)
Corresponding author
Owens, Andrew P.
ORCID
Venue
Frontiers in Integrative Neuroscience
Publisher
Frontiers Media SA
Published
2021-12-30
Volume
15
Pages
787037-787037
ISSN
1662-5145 (ISSN-L)
DOI
10.3389/fnint.2021.787037
PMC
PMC8756818
OpenAlex
W4200133633
Cited by
55
References
45
Citations by year
2026: 15 · 2025: 13 · 2024: 5 · 2023: 17 · 2022: 5
FWCI
6.34
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Integrative Neuroscience (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • Research Portal (King's College London) (submittedVersion, other-oa)
Topics
  • Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
Keywords
autism spectrum disorder, autonomic dysfunction, hypermobile Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome, vasovagal syncope, sympathoexcitation, orthostatic intolerance, essential hyperhidrosis, orthostatic hypotension, heart rate, blood pressure, sympathetic vasoconstriction, comorbidities

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