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School-age social behavior and pragmatic language ability in children with prenatal serotonin reuptake inhibitor exposure

Published online by Cambridge University Press:  07 February 2019

Erica L. Smearman ,
Cassandra L. Hendrix ,
Dominika A. Winiarski ,
Katrina C. Johnson ,
Alicia K. Smith ,
Opal Y. Ousley ,
Zachary N. Stowe ,
D. Jeffrey Newport  and
Patricia A. Brennan
Erica L. Smearman*
Affiliation:
Department of Psychology, Emory University, Atlanta, GA, USA Medical Scientist Training Program, Emory University School of Medicine, Atlanta, GA, USA
Cassandra L. Hendrix
Affiliation:
Department of Psychology, Emory University, Atlanta, GA, USA
Dominika A. Winiarski
Affiliation:
Section of Population Behavioral Health, Rush University Medical Center, Chicago, IL, USA
Katrina C. Johnson
Affiliation:
Department of Psychology, Emory University, Atlanta, GA, USA
Alicia K. Smith
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA Department of Gynecology & Obstetrics, Emory University, Atlanta, GA, USA
Opal Y. Ousley
Affiliation:
Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
Zachary N. Stowe
Affiliation:
Department of Psychiatry, University of Wisconsin, Madison, WI, USA
D. Jeffrey Newport
Affiliation:
Departments of Psychiatry & Behavioral Sciences and Obstetrics & Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
Patricia A. Brennan
Affiliation:
Department of Psychology, Emory University, Atlanta, GA, USA
*
Author for correspondence: Erica L. Smearman, Department of Psychology, 36 Eagle Row, Emory University, Atlanta, GA30322. E-mail: [email protected]
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Abstract

Studies examining associations between fetal serotonin reuptake inhibitor (SRI) exposure and child autism spectrum disorder (ASD) diagnoses or delayed language remain mixed and rarely prospectively follow children or employ gold-standard assessments. We prospectively followed a cohort of mother–child dyads from pregnancy through early elementary school (N = 178), and obtained maternal and alternate–caregiver ratings of behaviors related to ASD (N = 137), as well as direct, gold-standard assessments of child ASD symptoms and pragmatic language among dyads who experienced prenatal depression and either took SRIs or were medication free during pregnancy (N = 44). Prenatal SRI exposure was related to maternal ratings of ASD-related behaviors (β = 0.24 95% confidence interval; CI [0.07, 0.48]), and, among boys, alternative caregiver ratings (males-only β = 0.28 95% CI [0.02, 0.55], females-only β = −0.21 95% CI [–0.63, 0.08]). However, results of our direct assessments suggest an association between SRI exposure and reduced pragmatic language scores (β = –0.27, 95% CI [–0.53, –0.01], but not ASD (Autism Diagnostic Observation Schedule β = 0.14 95% CI [–0.15, 0.41]; Social Responsiveness Scale β = 0.08 95% CI [–0.25, 0.40]). These discrepancies point to issues regarding how ASD is assessed, and the possibility that SRIs may be more strongly associated with language or other broader behaviors that coincide with ASD. Larger prospective studies that incorporate thorough, gold-standard assessments of ASD, language, and other ASD-related behaviors are needed.

Keywords

Autism Spectrum Disorderlanguageneurodevelopmentprenatal exposureserotonin
Type
Regular Articles
Information
Development and Psychopathology , Volume 32 , Issue 1 , February 2020 , pp. 21 - 30
Copyright
Copyright © Cambridge University Press 2019

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References

Achenbach, T. (2001). Child behavior checklist for ages 6-18. Burlington, VT: ASEBA, University of Vermont.Google Scholar
Achenbach, T., & Rescorla, L. (2000). Child behavior checklist for ages 1 1/2-5. Burlington, VT: ASEBA, University of Vermont.Google Scholar
Anderson, G. M. (2002). Genetics of childhood disorders: XLV. Autism, part 4: serotonin in autism. Journal of the American Academy of Child & Adolescent Psychiatry, 41, 1513–1516.10.1097/00004583-200212000-00025CrossRefGoogle ScholarPubMed
Andrade, C. (2017). Antidepressant exposure during pregnancy and risk of autism in the offspring, 2: Do the new studies add anything new? The Journal of Clinical Psychiatry, 78, e1052–e1056. https://doi.org/10.4088/JCP.17f11916CrossRefGoogle ScholarPubMed
Austin, M. P. (2006). To treat or not to treat: maternal depression, SSRI use in pregnancy and adverse neonatal effects. Psychological Medicine, 36, 1663–1670.CrossRefGoogle ScholarPubMed
Beck, A., Steer, R., & Brown, G. (1996). Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.Google Scholar
Bérard, A., Boukhris, T., & Sheehy, O. (2016). Selective serotonin reuptake inhibitors and autism: additional data on the Quebec Pregnancy/Birth Cohort. American Journal of Obstetrics and Gynecology, 215, 803–805. https://doi.org/10.1016/j.ajog.2016.08.021CrossRefGoogle ScholarPubMed
Bérard, A., Zhao, J. P., & Sheehy, O. (2017). Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: an updated analysis of the Quebec Pregnancy Cohort. BMJ Open, 7, e013372.10.1136/bmjopen-2016-013372CrossRefGoogle Scholar
Bethea, C. L., Lu, N. Z., Gundlah, C., & Streicher, J. M. (2002). Diverse actions of ovarian steroids in the serotonin neural system. Frontiers in Neuroendocrinology, 23, 41–100.10.1006/frne.2001.0225CrossRefGoogle ScholarPubMed
Bethea, C. L., Pecins-Thompson, M., Schutzer, W. E., Gundlah, C. L. Z. N., & Lu, Z. N. (1998). Ovarian steroids and serotonin neural function. Molecular Neurobiology, 18, 87–123.10.1007/BF02914268CrossRefGoogle ScholarPubMed
Biederman, J., Petty, C. R., Fried, R., Wozniak, J., Micco, J. A., Henin, A., … Faraone, S. V. (2010). Child behavior checklist clinical scales discriminate referred youth with autism spectrum disorder: A preliminary study. Journal of Developmental & Behavioral Pediatrics, 31, 485–490. https://doi.org/10.1097/DBP.0b013e3181e56dddGoogle ScholarPubMed
Bölte, S., Poustka, F., & Constantino, J. N. (2008). Assessing autistic traits: Cross-cultural validation of the social responsiveness scale (SRS). Autism Research, 1, 354–363. https://doi.org/10.1002/aur.49CrossRefGoogle Scholar
Boukhris, T., & Bérard, A. (2015). Selective serotonin reuptake inhibitor use during pregnancy and the risk of autism spectrum disorders: A review. Journal of Pediatric Genetics, 4, 84–93.10.1055/s-0035-1556744CrossRefGoogle ScholarPubMed
Boukhris, T., Sheehy, O., & Mottron, L. (2015). Antidepressant use during pregnancy and the risk of autism spectrum disorder in children. JAMA Pediatrics, 170, 117–124.10.1001/jamapediatrics.2015.3356CrossRefGoogle Scholar
Brand, S. R., & Brennan, P. A. (2009). Impact of antenatal and postpartum maternal mental illness: How are the children? Clinical Obstetrics and Gynecology, 52, 441–455. https://doi.org/10.1097/GRF.0b013e3181b52930CrossRefGoogle Scholar
Brennan, P. A., Hammen, C., Andersen, M. J., Bor, W., Najman, J. M., & Williams, G. M. (2000). Chronicity, severity, and timing of maternal depressive symptoms: Relationships with child outcomes at age 5. Developmental Psychology, 36, 759–766.CrossRefGoogle ScholarPubMed
Brown, A. S., Gyllenberg, D., Malm, H., McKeague, I. W., Hinkka-Yli-Salomäki, S., Artama, M., … Sourander, A. (2016). Association of selective serotonin reuptake inhibitor exposure during pregnancy with speech, scholastic, and motor disorders in offspring. JAMA Psychiatry, 73, 1163–1170. https://doi.org/10.1001/jamapsychiatry.2016.2594CrossRefGoogle ScholarPubMed
Brown, H. K., Ray, J. G., Wilton, A. S., Lunsky, Y., Gomes, T., & Vigod, S. N. (2017). Association between serotonergic antidepressant use during pregnancy and autism spectrum disorder in children. JAMA, 317, 1544–1552. https://doi.org/10.1001/jama.2017.3415CrossRefGoogle ScholarPubMed
Carrow-Woolfolk, E. (1999). CASL: Comprehensive assessment of spoken language. Circle Pines, MN: American Guidance Services.Google Scholar
Castro, V. M., Kong, S. W., Clements, C. C., Brady, R., Kaimal, a J., Doyle, a E., … Perlis, R. H. (2016). Absence of evidence for increase in risk for autism or attention-deficit hyperactivity disorder following antidepressant exposure during pregnancy: A replication study. Translational Psychiatry, 6, e708. https://doi.org/10.1038/tp.2015.190CrossRefGoogle ScholarPubMed
Clements, C. C., Castro, V. M., Blumenthal, S. R., Rosenfield, H. R., Murphy, S. N., Fava, M., … Perlis, R. H. (2015). Prenatal antidepressant exposure is associated with risk for attention-deficit hyperactivity disorder but not autism spectrum disorder in a large health system. Molecular Psychiatry, 20, 727–734. https://doi.org/10.1038/mp.2014.90CrossRefGoogle ScholarPubMed
Constantino, J., & Gruber, C. (2007). Social responsiveness scale (SRS). Los Angeles, CA: Western Psychological Services.Google Scholar
Cooper, W. O., Willy, M. E., Pont, S. J., & Ray, W. A. (2007). Increasing use of antidepressants in pregnancy. American Journal of Obstetrics and Gynecology, 196, 544.e1-5. https://doi.org/10.1016/j.ajog.2007.01.033CrossRefGoogle ScholarPubMed
Croen, L. A., Grether, J. K., Yoshida, C. K., Odouli, R., & Hendrick, V. (2011). Antidepressant use during pregnancy and childhood autism spectrum disorders. Archives of General Psychiatry, 68, 1104–1112. https://doi.org/10.1001/archgenpsychiatry.2011.73CrossRefGoogle ScholarPubMed
Davalos, D. B., Yadon, C. A., & Tregellas, H. C. (2012). Untreated prenatal maternal depression and the potential risks to offspring: A review. Archives of Women's Mental Health, 15, 1–14. https://doi.org/10.1007/s00737-011-0251-1CrossRefGoogle ScholarPubMed
Elliott, C. D. (2007). Differential ability scales (2nd ed.). San Antonio, TX: Harcourt Assessment.Google Scholar
El Marroun, H., White, T. J. H., van der Knaap, N. J. F., Homberg, J. R., Fernández, G., Schoemaker, N. K., … Tiemeier, H. (2014). Prenatal exposure to selective serotonin reuptake inhibitors and social responsiveness symptoms of autism: Population-based study of young children. The British Journal of Psychiatry: The Journal of Mental Science, 205, 95–102. https://doi.org/10.1192/bjp.bp.113.127746CrossRefGoogle ScholarPubMed
Freire, C., de Oliveira, C.C.M., & Pereira Pondé, M. (2016). Antidepressants in pregnancy and autism spectrum disorder: A systematic review. Journal of Psychiatry, 19, 392. https://doi.org/10.4172/2378-5756.1000392Google Scholar
Gentile, S. (2015). Prenatal antidepressant exposure and the risk of autism spectrum disorders in children. Are we looking at the fall of Gods? Journal of Affective Disorders, 182, 132–137. https://doi.org/10.1016/j.jad.2015.04.048CrossRefGoogle ScholarPubMed
Gidaya, N. B., Lee, B. K., Burstyn, I., Yudell, M., Mortensen, E. L., & Newschaffer, C. J. (2014). In utero exposure to selective serotonin reuptake inhibitors and risk for autism spectrum disorder. Journal of Autism and Developmental Disorders, 44, 2558–2567. https://doi.org/10.1007/s10803-014-2128-4CrossRefGoogle ScholarPubMed
Grigoriadis, S., VonderPorten, E. H., Mamisashvili, L., Tomlinson, G., Dennis, C. L., Koren, G., … & Martinovic, J. (2013). The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. The Journal of clinical Psychiatry, 74, e321–e341. https://doi.org/10.4088/JCP.12r07968CrossRefGoogle ScholarPubMed
Hall, C., & Hamel, J. (2012). The role of comprehensive evaluation in the differential diagnosis of autism in a clinic setting. In International Meeting for Autism Research. Toronto, Ontario.Google Scholar
Handal, M., Skurtveit, S., Roth, C., Hernandez-Diaz, S., & Selmer, R. (2016). Prenatal exposure to folic acid and antidepressants and language development: A population-based cohort study. Journal of Clinical Psychopharmacology, 36, 333–339. https://doi.org/10.1097/JCP.0000000000000519CrossRefGoogle ScholarPubMed
Hanley, G. E., Brain, U., & Oberlander, T. F. (2015) Prenatal exposure to serotonin reuptake inhibitor antidepressants and childhood behavior. Pediatric Research, 78:174–180. doi: 10.1038/pr.2015.77CrossRefGoogle ScholarPubMed
Harrington, R. A., Lee, L.-C., Crum, R. M., Zimmerman, A. W., & Hertz-Picciotto, I. (2013). Serotonin hypothesis of autism: Implications for selective serotonin reuptake inhibitor use during pregnancy. Autism Research, 6, 149–168. https://doi.org/10.1002/aur.1288CrossRefGoogle ScholarPubMed
Harrington, R. A., Lee, L.-C., Crum, R. M., Zimmerman, A. W., & Hertz-Picciotto, I. (2014). Prenatal SSRI use and offspring with autism spectrum disorder or developmental delay. Pediatrics, 133, e1241–e1248. https://doi.org/10.1542/peds.2013-3406CrossRefGoogle ScholarPubMed
Healy, D., Le Noury, J., & Mangin, D. (2016). Links between serotonin reuptake inhibition during pregnancy and neurodevelopmental delay/spectrum disorders: A systematic review of epidemiological and physiological evidence. International Journal of Risk & Safety in Medicine, 28, 125–141. https://doi.org/10.3233/JRS-160726CrossRefGoogle ScholarPubMed
Hresko, W. P., Reid, D. K., & Hammill, D. D. (1999). Test of early language development. Austin, TX: Pro-ed.Google Scholar
Huybrechts, K. F., Palmsten, K., Avorn, J., Cohen, L. S., Holmes, L. B., Franklin, J. M., … & Hernández-Díaz, S. (2014). Antidepressant use in pregnancy and the risk of cardiac defects. New England Journal of Medicine, 370, 2397–2407.CrossRefGoogle ScholarPubMed
Huybrechts, K. F., Palmsten, K., Mogun, H., Kowal, M., Avorn, J., Setoguchi-Iwata, S., & Hernández-Díaz, S. (2013). National trends in antidepressant medication treatment among publicly insured pregnant women. General Hospital Psychiatry, 35, 265–271.CrossRefGoogle ScholarPubMed
Hviid, A., Melbye, M., & Pasternak, B. (2013). Use of selective serotonin reuptake inhibitors during pregnancy and risk of autism. New England Journal of Medicine, 369, 2406–2415. https://doi.org/10.1056/NEJMoa1301449CrossRefGoogle ScholarPubMed
Johnson, K. C., Smith, A. K., Stowe, Z. N., Newport, D. J., & Brennan, P. A. (2016). Preschool outcomes following prenatal serotonin reuptake inhibitor exposure: Differences in language and behavior, but not cognitive function. The Journal of Clinical Psychiatry, 77, e176–e182. https://doi.org/10.4088/JCP.14m09348CrossRefGoogle Scholar
Kobayashi, T., Matsuyama, T., Takeuchi, M., & Ito, S. (2016). Autism spectrum disorder and prenatal exposure to selective serotonin reuptake inhibitors: A systematic review and meta-analysis. Reproductive Toxicology, 65, 170–178. https://doi.org/10.1016/j.reprotox.2016.07.016CrossRefGoogle ScholarPubMed
Lattimore, K. A., Donn, S. M., Kaciroti, N., Kemper, A. R., Neal, C. R., & Vazquez, D. M. (2005). Selective serotonin reuptake inhibitor (SSRI) use during pregnancy and effects on the fetus and newborn: A meta-analysis. Journal of Perinatology, 25, 595–604. https://doi.org/10.1038/sj.jp.7211352CrossRefGoogle ScholarPubMed
Liu, X., Agerbo, E., Ingstrup, K. G., Musliner, K., Meltzer-Brody, S., Bergink, V., & Munk-Olsen, T. (2017). Antidepressant use during pregnancy and psychiatric disorders in offspring: Danish nationwide register based cohort study. BMJ, 358, j3668. https://doi.org/10.1136/BMJ.J3668CrossRefGoogle ScholarPubMed
Lord, C., Risi, S., Lambrecht, L., Cook, E. H., Leventhal, B. L., DiLavore, P. C., … Rutter, M. (2000). The autism diagnostic observation schedule-generic: A standard measure of social and communication deficits associated with the spectrum of autism. Journal of Autism and Developmental Disorders, 30, 205–223.CrossRefGoogle ScholarPubMed
Lundström, S., Reichenberg, A., Anckarsäter, H., Lichtenstein, P., & Gillberg, C. (2015). Autism phenotype versus registered diagnosis in Swedish children: Prevalence trends over 10 years in general population samples. BMJ, 350, h1961. https://doi.org/10.1136/BMJ.H1961CrossRefGoogle ScholarPubMed
Lupattelli, A., Wood, M., Ystrom, E., Skurtveit, S., Handal, M., & Nordeng, H. (2018). Effect of time-dependent selective serotonin reuptake inhibitor antidepressants during pregnancy on behavioral, emotional, and social development in preschool-aged children. Journal of the American Academy of Child & Adolescent Psychiatry, 57, 200–208. doi: 10.1016/j.jaac.2017.12.010CrossRefGoogle ScholarPubMed
Malm, H., Brown, A. S., Gissler, M., Gyllenberg, D., Hinkka-Yli-Salomäki, S., McKeague, I. W., … & Sourander, A. (2016). Gestational exposure to selective serotonin reuptake inhibitors and offspring psychiatric disorders: A national register-based study. Journal of the American Academy of Child & Adolescent Psychiatry, 55, 359–366.CrossRefGoogle ScholarPubMed
Maloney, S. E., Rahn, R., Akula, S., Rieger, M. A., McCullough, K. B., Jakes, C., … Dougherty, J. D. (2017). Maternal SSRI treatment during offspring development results in long-term behavioral, cellular, and neuroimaging disruptions. bioRxiv, 205708. https://doi.org/10.1101/205708Google Scholar
Man, K. K. C., Tong, H. H. Y., Wong, L. Y. L., Chan, E. W., Simonoff, E., & Wong, I. C. K. (2015). Exposure to selective serotonin reuptake inhibitors during pregnancy and risk of autism spectrum disorder in children: A systematic review and meta-analysis of observational studies. Neuroscience and Biobehavioral Reviews, 49, 82–89. https://doi.org/10.1016/j.neubiorev.2014.11.020CrossRefGoogle ScholarPubMed
Mezzacappa, A., Lasica, P.-A., Gianfagna, F., Cazas, O., Hardy, P., Falissard, B., … Gressier, F. (2017). Risk for autism spectrum disorders according to period of prenatal antidepressant exposure: A systematic review and meta-analysis. JAMA Pediatrics, 171, 555–563. https://doi.org/10.1001/jamapediatrics.2017.0124CrossRefGoogle ScholarPubMed
Newport, D., Brennan, P., Green, P., Ilardi, D., Whitfield, T., Morris, N., … Stowe, Z. (2008). Maternal depression and medication exposure during pregnancy: Comparison of maternal retrospective recall to prospective documentation. BJOG: An International Journal of Obstetrics and Gynaecology, 115, 681–688. https://doi.org/10.1111/j.1471-0528.2008.01701.xCrossRefGoogle ScholarPubMed
Nulman, I., Koren, G., Rovet, J., Barrera, M., Streiner, D. L., & Feldman, B. M. (2015). Neurodevelopment of children prenatally exposed to selective reuptake inhibitor antidepressants: Toronto sibling study. The Journal of clinical psychiatry, 76, e842–e847.CrossRefGoogle ScholarPubMed
O'Donnell, K. J., Glover, V., Jenkins, J., Browne, D., Ben-Shlomo, Y., Golding, J., & O'Connor, T. G. (2013). Prenatal maternal mood is associated with altered diurnal cortisol in adolescence. Psychoneuroendocrinology, 38, 1630–1638. https://doi.org/10.1016/j.psyneuen.2013.01.008CrossRefGoogle ScholarPubMed
Pedersen, L. H., Henriksen, T. B., & Olsen, J. (2010). Fetal exposure to antidepressants and normal milestone development at 6 and 19 months of age. Pediatrics, 125, e600–e608. doi:10.1542/peds.2008-3655CrossRefGoogle Scholar
Pratt, L. A., Brody, D. J., & Gu, Q. (2011). Antidepressant use in persons aged 12 and over: United States, 2005-2008. NCHS Data Brief, (76), 1–8.Google Scholar
Rai, D., Lee, B. K., Dalman, C., Golding, J., Lewis, G., & Magnusson, C. (2013). Parental depression, maternal antidepressant use during pregnancy, and risk of autism spectrum disorders: Population based case-control study. BMJ (Clinical Research Ed.), 346, f2059. https://doi.org/10.1136/BMJ.F2059Google ScholarPubMed
Rai, D., Lee, B. K., Dalman, C., Newschaffer, C., Lewis, G., & Magnusson, C. (2017). Antidepressants during pregnancy and autism in offspring: population based cohort study. BMJ, 358, j2811.Google ScholarPubMed
Rampono, J., Simmer, K., Ilett, K. F., Hackett, L. P., Doherty, D. A., Elliot, R., … Forman, T. (2009). Placental transfer of SSRI and SNRI antidepressants and effects on the neonate. Pharmacopsychiatry, 42, 95–100. https://doi.org/10.1055/s-0028-1103296CrossRefGoogle ScholarPubMed
Reichow, B., Salamack, S., Paul, R., Volkmar, F. R., & Klin, A. (2008). Pragmatic assessment in autism spectrum disorders: A comparison of a standard measure with parent report. Communication Disorders Quarterly, 29, 169–176. https://doi.org/10.1177/1525740108318697CrossRefGoogle ScholarPubMed
Skurtveit, S., Selmer, R., Roth, C., Hernandez-Diaz, S., & Handal, M. (2014). Prenatal exposure to antidepressants and language competence at age three: Results from a large population-based pregnancy cohort in Norway. BJOG: An International Journal of Obstetrics & Gynaecology, 121, 1621–1631. https://doi.org/10.1111/1471-0528.12821CrossRefGoogle ScholarPubMed
Sørensen, M. J., Grønborg, T. K., Christensen, J., Parner, E. T., Vestergaard, M., Schendel, D., & Pedersen, L. H. (2013). Antidepressant exposure in pregnancy and risk of autism spectrum disorders. Clinical Epidemiology, 5, 449–459. https://doi.org/10.2147/CLEP.S53009CrossRefGoogle ScholarPubMed
Sujan, A. C., Rickert, M. E., Öberg, A. S., Quinn, P. D., Hernández-Díaz, S., Almqvist, C., … D'Onofrio, B. M. (2017). Associations of maternal antidepressant use during the first trimester of pregnancy with preterm birth, small for gestational age, autism spectrum disorder, and attention-deficit/hyperactivity disorder in offspring. JAMA, 317, 1553–1562. https://doi.org/10.1001/jama.2017.3413CrossRefGoogle ScholarPubMed
Swales, D. A., Winiarski, D. A., Smith, A. K., Stowe, Z. N., Newport, D. J., Brennan, P. A. (2018). Maternal depression and cortisol in pregnancy predict offspring emotional reactivity in the preschool period. Developmental Psychobiology, 60, 557–566. https://doi.org/10.1002/dev.21631CrossRefGoogle ScholarPubMed
Viktorin, A., Uher, R., Reichenberg, A., Levine, S. Z., & Sandin, S. (2017). Autism risk following antidepressant medication during pregnancy. Psychological Medicine, 47, 2787–2796. https://doi.org/10.1017/S0033291717001301CrossRefGoogle ScholarPubMed
Whitaker-Azmitia, P. M. (2001). Serotonin and brain development: Role in human developmental diseases. Brain Research Bulletin, 56, 479–485.CrossRefGoogle ScholarPubMed
Yirmiya, N., & Shaked, M. (2005). Psychiatric disorders in parents of children with autism: A meta-analysis. Journal of Child Psychology and Psychiatry, 46, 69–83.CrossRefGoogle ScholarPubMed