Face processing occurs outside the fusiform 'face area' in autism: evidence from functional MRI

Impaired Face Processing in Autism: Fact or Artifact?

Within the last 10 years, there has been an upsurge of interest in face processing abilities in autism which has generated a proliferation of new empirical demonstrations employing a variety of measuring techniques. Observably atypical social behaviors early in the development of children with autism have led to the contention that autism is a condition where the processing of social information, particularly faces, is impaired. While several empirical sources of evidence lend support to this hypothesis, others suggest that there are conditions under which autistic individuals do not differ from typically developing persons. The present paper reviews this bulk of empirical evidence, and concludes that the versatility and abilities of face processing in persons with autism have been underestimated.

Finding a face in the crowd: testing the anger superiority effect in Asperger Syndrome

Social threat captures attention and is processed rapidly and efficiently, with many lines of research showing involvement of the amygdala. Visual search paradigms looking at social threat have shown angry faces 'pop-out' in a crowd, compared to happy faces. Autism and Asperger Syndrome (AS) are neurodevelopmental conditions characterised by social deficits, abnormal face processing, and amygdala dysfunction. We tested adults with high-functioning autism (HFA) and AS using a facial visual search paradigm with schematic neutral and emotional faces. We found, contrary to predictions, that people with HFA/AS performed similarly to controls in many conditions. However, the effect was reduced in the HFA/AS group when using widely varying crowd sizes and when faces were inverted, suggesting a difference in face-processing style may be evident even with simple schematic faces. We conclude there are intact threat detection mechanisms in AS, under simple and predictable conditions, but that like other face-perception tasks, the visual search of threat faces task reveals atypical face-processing in HFA/AS.

Facial affect recognition training in autism: Can we animate the fusiform gyrus?

One of the most consistent findings in the neuroscience of autism is hypoactivation of the fusiform gyrus (FG) during face processing. In this study the authors examined whether successful facial affect recognition training is associated with an increased activation of the FG in autism. The effect of a computer-based program to teach facial affect identification was examined in 10 individuals with high-functioning autism. Blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) changes in the FG and other regions of interest, as well as behavioral facial affect recognition measures, were assessed pre- and posttraining. No significant activation changes in the FG were observed. Trained participants showed behavioral improvements, which were accompanied by higher BOLD fMRI signals in the superior parietal lobule and maintained activation in the right medial occipital gyrus.

Discrimination of temporal synchrony in intermodal events by children with autism and children with developmental disabilities without autism

BACKGROUND

This project examined the intermodal perception of temporal synchrony in 16 young children (ages 4 to 6 years) with autism compared to a group of children without impairments matched on adaptive age, and a group of children with other developmental disabilities matched on chronological and adaptive age.

METHOD

A preferential looking paradigm was used, where participants viewed non-linguistic, simple linguistic or complex linguistic events on two screens displaying identical video tracks, but one offset from the other by 3 seconds, and with the single audio track matched to only one of the displays.

RESULTS

As predicted, both comparison groups demonstrated significant non-random preferential looking to violations of temporal synchrony with linguistic and non-linguistic stimuli. However, the group with autism showed an impaired, chance level of responding, except when presented with non-linguistic stimuli.

CONCLUSIONS

Several explanations are offered for this apparently autism-specific, language-specific pattern of responding to temporal synchrony, and potential developmental sequelae are discussed.

Demonstrations of Decreased Sensitivity to Complex Motion Information Not Enough to Propose an Autism-Specific Neural Etiology

Interest regarding neural information processing in autism is growing because atypical perceptual abilities are a characteristic feature of persons with autism. Central to our review is how characteristic perceptual abilities, referred to as perceptual signatures, can be used to suggest a neural etiology that is specific to autism. We review evidence from studies assessing both motion and form perception and how the resulting perceptual signatures are interpreted within the context of two main hypotheses regarding information processing in autism: the pathway- and complexity-specific hypotheses. We present evidence suggesting that an autism-specific neural etiology based on perceptual abilities can only be made when particular experimental paradigms are used, and that such an etiology is most congruent with the complexity-specific hypothesis.

Large brains in autism: the challenge of pervasive abnormality

The most replicated finding in autism neuroanatomy-a tendency to unusually large brains-has seemed paradoxical in relation to the specificity of the abnormalities in three behavioral domains that define autism. We now know a range of things about this phenomenon, including that brains in autism have a growth spurt shortly after birth and then slow in growth a few short years afterward, that only younger but not older brains are larger in autism than in controls, that white matter contributes disproportionately to this volume increase and in a nonuniform pattern suggesting postnatal pathology, that functional connectivity among regions of autistic brains is diminished, and that neuroinflammation (including microgliosis and astrogliosis) appears to be present in autistic brain tissue from childhood through adulthood. Alongside these pervasive brain tissue and functional abnormalities, there have arisen theories of pervasive or widespread neural information processing or signal coordination abnormalities (such as weak central coherence, impaired complex processing, and underconnectivity), which are argued to underlie the specific observable behavioral features of autism. This convergence of findings and models suggests that a systems- and chronic disease-based reformulation of function and pathophysiology in autism needs to be considered, and it opens the possibility for new treatment targets.

The neurophysiological correlates of face processing in adults and children with Asperger’s syndrome

Past research has found evidence for face and emotional expression processing differences between individuals with Asperger's syndrome (AS) and neurotypical (NT) controls at both the neurological and behavioural levels. The aim of the present study was to examine the neurophysiological basis of emotional expression processing in children and adults with AS relative to age- and gender-matched NT controls. High-density event-related potentials were recorded during explicit processing of happy, sad, angry, scared, and neutral faces. Adults with AS were found to exhibit delayed P1 and N170 latencies and smaller N170 amplitudes in comparison to control subjects for all expressions. This may reflect impaired holistic and configural processing of faces in AS adults. However, these differences were not observed between AS and control children. This may result from incomplete development of the neuronal generators of these ERP components and/or early intervention.

Autism: a window onto the development of the social and the analytic brain

Although the neurobiological understanding of autism has been increasing exponentially, the diagnosis of autism spectrum conditions still rests entirely on behavioral criteria. Autism is therefore most productively approached using a combination of biological and psychological theory. The triad of behavioral abnormalities in social function, communication, and restricted and repetitive behaviors and interests can be explained psychologically by an impaired capacity for empathizing, or modeling the mental states governing the behavior of people, along with a superior capacity for systemizing, or inferring the rules governing the behavior of objects. This empathizing-systemizing theory explains other psychological models such as impairments of executive function or central coherence, and may have a neurobiological basis in abnormally low activity of brain regions subserving social cognition, along with abnormally high activity of regions subserving lower-level, perceptual processing--a pattern that may result from a skewed balance of local versus long-range functional connectivity.

Responding to the emotions of others: dissociating forms of empathy through the study of typical and psychiatric populations

Empathy is a lay term that is becoming increasingly viewed as a unitary function within the field of cognitive neuroscience. In this paper, a selective review of the empathy literature is provided. It is argued from this literature that empathy is not a unitary system but rather a loose collection of partially dissociable neurocognitive systems. In particular, three main divisions can be made: cognitive empathy (or Theory of Mind), motor empathy, and emotional empathy. The two main psychiatric disorders associated with empathic dysfunction are considered: autism and psychopathy. It is argued that individuals with autism show difficulties with cognitive and motor empathy but less clear difficulties with respect to emotional empathy. In contrast, individuals with psychopathy show clear difficulties with a specific form of emotional empathy but no indications of impairment with cognitive and motor empathy.

Laterality biases to chimeric faces in Asperger syndrome: what is 'right' about face-processing?

People show a left visual field (LVF) bias for faces, i.e., involving the right hemisphere of the brain. Lesion and neuroimaging studies confirm the importance of the right-hemisphere and suggest separable neural pathways for processing facial identity vs. emotions. We investigated the hemispheric processing of faces in adults with and without Asperger syndrome (AS) using facial emotion and identity chimeric tasks. Controls showed an LVF bias in both tasks, but no perceptual bias in a non-social control task. The AS group showed an LVF bias during both tasks, however the bias was reduced in the identity condition. Further, the AS group showed an LVF bias in the non-social condition. These results show a differential pattern of hemispheric processing of faces in AS.

The role of the medial temporal lobe in autistic spectrum disorders

The neural basis of autistic spectrum disorders (ASDs) is poorly understood. Studies of mnemonic function in ASD suggest a profile of impaired episodic memory with relative preservation of semantic memory (at least in high-functioning individuals). Such a pattern is consistent with developmental hippocampal abnormality. However, imaging evidence for abnormality of the hippocampal formation in ASD is inconsistent. These inconsistencies led us to examine the memory profile of children with ASD and the relationship to structural abnormalities. A cohort of high-functioning individuals with ASD and matched controls completed a comprehensive neuropsychological memory battery and underwent magnetic resonance imaging for the purpose of voxel-based morphometric analyses. Correlations between cognitive/behavioural test scores and quantified results of brain scans were also carried out to further examine the role of the medial temporal lobe in ASD. A selective deficit in episodic memory with relative preservation of semantic memory was found. Voxel-based morphometry revealed bilateral abnormalities in several areas implicated in ASD including the hippocampal formation. A significant correlation was found between parental ratings reflecting autistic symptomatology and the measure of grey matter density in the junction area involving the amygdala, hippocampus and entorhinal cortex. The data reveal a pattern of impaired and relatively preserved mnemonic function that is consistent with a hippocampal abnormality of developmental origin. The structural imaging data highlight abnormalities in several brain regions previously implicated in ASD, including the medial temporal lobes.

Abnormal activation of face processing systems at early and intermediate latency in individuals with autism spectrum disorder: a magnetoencephalographic study

The neurological basis of developmental psychopathology in autism is a matter of intense debate. Magnetoencephalography (MEG) was used to study the neuronal responses associated with the processing of faces in 12 able adults with autism spectrum disorders (ASD), performing image categorization and image identification tasks. The neuromagnetic data were analysed using nonparametric time-series analysis and equivalent current dipole estimation. Comparison data were obtained from 22 normally developing adults. In individuals with ASD, the neural responses to images of faces, observed in right extrastriate cortices at approximately 145 ms after stimulus onset, were significantly weaker, less lateralized and less affected by stimulus repetition than in control subjects. Early latency (30-60 ms) responses to face images, over right anterior temporal regions, differed significantly between the two subject groups in the image identification task. No such difference was observed for images of mugs or meaningless geometrical patterns. These findings suggest that, during the course of development in individuals with ASD, the cortical activity associated with the processing of human faces assumes a different-from-normal localization in extrastriate brain regions. This abnormal localization may be associated with unusual, but nevertheless face-specific, fast processing pathways.

Enhanced and diminished visuo-spatial information processing in autism depends on stimulus complexity

Visuo-perceptual processing in autism is characterized by intact or enhanced performance on static spatial tasks and inferior performance on dynamic tasks, suggesting a deficit of dorsal visual stream processing in autism. However, previous findings by Bertone et al. indicate that neuro-integrative mechanisms used to detect complex motion, rather than motion perception per se, may be impaired in autism. We present here the first demonstration of concurrent enhanced and decreased performance in autism on the same visuo-spatial static task, wherein the only factor dichotomizing performance was the neural complexity required to discriminate grating orientation. The ability of persons with autism was found to be superior for identifying the orientation of simple, luminance-defined (or first-order) gratings but inferior for complex, texture-defined (or second-order) gratings. Using a flicker contrast sensitivity task, we demonstrated that this finding is probably not due to abnormal information processing at a sub-cortical level (magnocellular and parvocellular functioning). Together, these findings are interpreted as a clear indication of altered low-level perceptual information processing in autism, and confirm that the deficits and assets observed in autistic visual perception are contingent on the complexity of the neural network required to process a given type of visual stimulus. We suggest that atypical neural connectivity, resulting in enhanced lateral inhibition, may account for both enhanced and decreased low-level information processing in autism.

Memory and learning in children with 22q11.2 deletion syndrome: evidence for ventral and dorsal stream disruption?

This study examined memory functioning in children and adolescents with 22q11.2 Deletion Syndrome (DS; velocardiofacial syndrome). An overall verbal better than nonverbal memory pattern was evident on the Test of Memory and Learning (TOMAL), with children with 22q11.2 DS performing significantly below their siblings and children with low average IQ but similar to children with autism on facial memory. Children with 22q11 DS also performed significantly below their siblings on tests of verbal working memory. Children with autism performed significantly poorer than the siblings of children with 22q11.2 DS only on their recall of stories. Delayed recall was significantly poorer in children with 22q11.2 DS and children with autism, compared to sibling controls. Although there were no significant group differences on tests of multiple trial verbal or visual learning, a relative weakness was noted with multiple trial visual learning in children with 22q11.2 DS and their siblings, suggesting that an alternative or interactive factor other than the deletion may account for the relatively better verbal compared to nonverbal memory abilities. Deficits in facial memory in children with both 22q11.2 DS and autism suggest disruptions in ventral temporal pathways such as between fusiform gyrus and parahippocampal/hippocampal regions whereas deficits in verbal working memory in children with 22q11.2 DS implicates dorsolateral prefrontal regions, both intimating aberrant white matter pathways.

Neural correlates of eye-gaze detection in young children with autism

Various reports have demonstrated difficulties in eye-gaze processing in older children and adults with autism. However, little is known about the neural or developmental origin of such difficulties. In the present study, we used high-density Event-Related Potentials (HD-ERPs) to record the neural correlates of gaze processing in young children with autism, and their age-matched controls. In addition, to determine normal gaze processing development we also tested a non-autism adult group. The data obtained from the children with autism resembled that previously observed in typical 4-month old infants. In contrast, the control group showed the same pattern as typical adults. These findings suggest that the neural correlates of gaze direction processing may be delayed in young children with autism.

Developmental deficits in social perception in autism: the role of the amygdala and fusiform face area

Autism is a severe developmental disorder marked by a triad of deficits, including impairments in reciprocal social interaction, delays in early language and communication, and the presence of restrictive, repetitive and stereotyped behaviors. In this review, it is argued that the search for the neurobiological bases of the autism spectrum disorders should focus on the social deficits, as they alone are specific to autism and they are likely to be most informative with respect to modeling the pathophysiology of the disorder. Many recent studies have documented the difficulties persons with an autism spectrum disorder have accurately perceiving facial identity and facial expressions. This behavioral literature on face perception abnormalities in autism is reviewed and integrated with the functional magnetic resonance imaging (fMRI) literature in this area, and a heuristic model of the pathophysiology of autism is presented. This model posits an early developmental failure in autism involving the amygdala, with a cascading influence on the development of cortical areas that mediate social perception in the visual domain, specifically the fusiform "face area" of the ventral temporal lobe. Moreover, there are now some provocative data to suggest that visual perceptual areas of the ventral temporal pathway are also involved in important ways in representations of the semantic attributes of people, social knowledge and social cognition. Social perception and social cognition are postulated as normally linked during development such that growth in social perceptual skills during childhood provides important scaffolding for social skill development. It is argued that the development of face perception and social cognitive skills are supported by the amygdala-fusiform system, and that deficits in this network are instrumental in causing autism.

Patterns of cognitive and emotional empathy in frontotemporal lobar degeneration

OBJECTIVE

To examine the relationship between empathy and cognition in frontotemporal lobar degeneration (FTLD).

BACKGROUND

Theoretical models suggest empathy has multiple cognitive and affective subcomponents, and recent studies suggest that performance on specific cognitive tests may predict empathy. Qualitative behavioral studies of patients with FTLD suggest empathy loss may occur directly as a result of damage to frontal and temporal structures.

METHOD

First-degree relatives used the Interpersonal Reactivity Index (IRI), a measure of cognitive and emotional empathy, to rate 18 patients with frontotemporal dementia (FTD), 19 patients with semantic dementia (SD), 16 patients with Alzheimer disease (AD), and 10 age-matched healthy control subjects (NC). Subjects also underwent cognitive testing.

RESULTS

Both FTD and SD groups showed significantly lower levels of empathy than either ADs or NCs. SDs showed disruption of both emotional and cognitive empathy, whereas FTDs showed only disruption of cognitive empathy. Regressions controlling for general cognitive impairment showed 32% of the variance in Perspective Taking score was predicted by Category Fluency (P < 0.001), and 25% of the variance in Fantasy score was accounted for by Phonemic Fluency (P < 0.001).

CONCLUSIONS

Although cognitive empathy is at least partly reliant on frontal structures, the emotional components of empathy are likely mediated by structures in the temporal lobes.

Structural white matter deficits in high-functioning individuals with autistic spectrum disorder: a voxel-based investigation

A number of imaging and neuropathological studies have reported structural abnormalities in white matter areas such as the corpus callosum in autism spectrum disorder (ASD). Differences in both global brain volume and the size of specific neural structures have been reported. In order to expand these previously reported findings and to describe more precisely the nature of such structural changes, we performed a voxel-based morphometric whole brain analysis, using a group-specific template, in male adolescents with ASD. Fifteen individuals with normal intelligence and ASD, and a group of 16 controls, matched for age, sex, and IQ, were investigated. High-resolution T1-weighted 3D data sets were acquired and analysed. Local white matter volume deficits were found in the corpus callosum, particularly in the anterior splenium and isthmus, and right hemisphere. White matter volume deficits were also found in the left middle temporal, right middle frontal, and left superior frontal gyri. No significant areas of increased white matter volume were found. Our findings support the hypothesis that reduced white matter volume in the corpus callosum and right hemisphere may play a role in the pathophysiology of ASD.

fMRI activation of the fusiform gyrus and amygdala to cartoon characters but not to faces in a boy with autism

Abnormal hypoactivation in the amygdala and fusiform gyrus, brain areas that participate in face processing and social cognition, has consistently been demonstrated in persons with autism. We investigated activity in these areas in a boy with autism, DD, who had a special interest in "Digimon" cartoon characters. DD individuates Digimon faster than familiar faces and objects, but he individuates familiar faces no faster than objects. In contrast, a typically developing boy with an interest in "Pokemon" cartoon characters is equally fast at individuating faces and Pokemon and faster at individuating faces and Pokemon than objects and Digimon. In addition, using functional magnetic resonance imaging (fMRI), we show that DD activates his amygdala and fusiform gyrus for perceptual discriminations involving Digimon but not for those involving familiar or unfamiliar faces. This pattern of activation is not seen in the typically developing control with an interest in Pokemon or in a second comparison case who has autism but no interest in Digimon. These results have important implications for our understanding of autism, cortical face specialization, and the possible role of the amygdala in the development of perceptual expertise.

Bedeutung und Ergebnisse der Theory of Mind-Forschung für den Autismus und andere psychiatrische Erkrankungen

Zusammenfassung: Erkrankungen des autistischen Spektrums sind im Wesentlichen durch folgende Symptomtriade gekennzeichnet: Störung der sozialen Interaktion, Störung der Kommunikation, sowie stereotype Verhaltensmuster und Interessen. Einer der prominentesten Ansätze zur Erklärung dieser Auffälligkeiten stellt die «Theory of Mind» dar ( Baron-Cohen et al., 1985 ). Die vorliegende Übersichtsarbeit diskutiert den aktuellen Forschungsstand hierzu und stellt wesentliche Ergebnisse der letzten 10 Jahre zusammenfassend dar. Gleichzeitig werden diese kritisch hinsichtlich ihrer Bedeutsamkeit für die Erklärung anderer psychiatrischer Erkrankungen und ihrer methodischen Qualität betrachtet. Trotz der vielfältigen Forschungsbemühungen zu diesem Thema stellen die unterschiedlichen Störungskonzepte noch kein einheitliches Rahmenmodell zur Entstehung der Erkrankungen des autistischen Spektrums dar. Zukünftige Forschung sollte sich zum Ziel setzen, den Erklärungswert der einzelnen theoretischen Modelle genauer zu überprüfen und Gemeinsamkeiten der verschiedenen Konzepte herauszustellen, um so gezieltere Informationen über potentielle Verursachungsfaktoren von Autismus zu bekommen.

Repetitive Behavior Profiles in Asperger Syndrome and High-Functioning Autism

Although repetitive behaviors are a core diagnostic domain for autism spectrum disorders, research in this area has been neglected. This study had two major aims: (1) to provide a detailed characterization of repetitive behaviors in individuals with Asperger Syndrome (AS), high-functioning autism (HFA), and typically developing controls (TD); and (2) to examine whether differences in repetitive behavior profiles could provide evidence for the external validity of AS separate from HFA. Specifically, it was hypothesized that circumscribed interests would be more prevalent and cause more impairment in the AS group than the HFA group, while the reverse would be true for other categories of repetitive behavior. The parent(s) of 61 children and adolescents (19 with AS, 21 with HFA, and 21 TD) completed two interviews focused specifically on lifetime and current repetitive behavior symptoms. No reliable differences in repetitive behavior between AS and HFA children were found. Results suggested that circumscribed interests differ in developmental course from the three other DSM-IV-TR categories of repetitive behavior. Internal consistency among the four DSM-IV-TR categories of repetitive behavior was high, alpha = .84, providing evidence for a unitary repetitive behaviors factor. The importance of expanding research in the repetitive behavior domain is highlighted as part of the necessary integration of behavioral and neurobiological approaches to understanding the etiology of autism.

Gaze fixation and the neural circuitry of face processing in autism

Diminished gaze fixation is one of the core features of autism and has been proposed to be associated with abnormalities in the neural circuitry of affect. We tested this hypothesis in two separate studies using eye tracking while measuring functional brain activity during facial discrimination tasks in individuals with autism and in typically developing individuals. Activation in the fusiform gyrus and amygdala was strongly and positively correlated with the time spent fixating the eyes in the autistic group in both studies, suggesting that diminished gaze fixation may account for the fusiform hypoactivation to faces commonly reported in autism. In addition, variation in eye fixation within autistic individuals was strongly and positively associated with amygdala activation across both studies, suggesting a heightened emotional response associated with gaze fixation in autism.

Brain overgrowth in autism during a critical time in development: implications for frontal pyramidal neuron and interneuron development and connectivity

While abnormalities in head circumference in autism have been observed for decades, it is only recently that scientists have begun to focus in on the developmental origins of such a phenomenon. In this article we review past and present literature on abnormalities in head circumference, as well as recent developmental MRI studies of brain growth in this disorder. We hypothesize that brain growth abnormalities are greatest in frontal lobes, particularly affecting large neurons such as pyramidal cells, and speculate how this abnormality might affect neurofunctional circuitry in autism. The relationship to clinical characteristics and other disorders of macrencephaly are discussed.

Neuroepileptic correlates of autistic symptomatology in tuberous sclerosis

Tuberous sclerosis is a genetic condition that is strongly associated with the development of an autism spectrum disorder. However, there is marked variability in expression, and only a subset of children with tuberous sclerosis develop autism spectrum disorder. Clarification of the mechanisms that underlie the association and variability in expression will potentially throw light on the biological processes involved in the etiology of idiopathic forms of autism spectrum disorder. Current evidence indicates that the likelihood of a child with tuberous sclerosis developing an autism spectrum disorder is greater if the child has a mutation in the TSC2 gene, although autism can and does develop in children with TSC1 mutations. The likelihood is also greater if the child has early-onset infantile spasms that are difficult to control, especially if there is an epileptiform focus in the temporal lobes. The emerging evidence is consistent with the notion that early onset electrophysiological disturbances within the temporal lobes (and perhaps other locations) has a deleterious effect on the development and establishment of key social cognitive representations concerned with processing social information, perhaps especially from faces. However, alternative mechanisms to account for the findings cannot yet be ruled out. Future research will have to employ prospective longitudinal designs and treatment trials to clarify the processes involved.

Brain Activation during Face Perception: Evidence of a Developmental Change

Behavioral studies suggest that children under age 10 process faces using a piecemeal strategy based on individual distinctive facial features, whereas older children use a configural strategy based on the spatial relations among the face's features. The purpose of this study was to determine whether activation of the fusiform gyrus, which is involved in face processing in adults, is greater during face processing in older children (12–14 years) than in younger children (8– 10 years). Functional MRI scans were obtained while children viewed faces and houses. A developmental change was observed: Older children, but not younger children, showed significantly more activation in bilateral fusiform gyri for faces than for houses. Activation in the fusiform gyrus correlated significantly with age and with a behavioral measure of configural face processing. Regions believed to be involved in processing basic facial features were activated in both younger and older children. Some evidence was also observed for greater activation for houses versus faces for the older children than for the younger children, suggesting that processing of these two stimulus types becomes more differentiated as children age. The current results provide biological insight into changes in visual processing of faces that occur with normal development.

Functional connectivity in an fMRI working memory task in high-functioning autism

An fMRI study was used to measure the brain activation of a group of adults with high-functioning autism compared to a Full Scale and Verbal IQ and age-matched control group during an n-back working memory task with letters. The behavioral results showed comparable performance, but the fMRI results suggested that the normal controls might use verbal codes to perform the task, while the adults with autism might use visual codes. The control group demonstrated more activation in the left than the right parietal regions, whereas the autism group showed more right lateralized activation in the prefrontal and parietal regions. The autism group also had more activation than the control group in the posterior regions including inferior temporal and occipital regions. The analysis of functional connectivity yielded similar patterns for the two groups with different hemispheric correlations. The temporal profile of the activity in the prefrontal regions was more correlated with the left parietal regions for the control group, whereas it was more correlated with the right parietal regions for the autism group.

What is Known About Autism

Autism is a neurodevelopmental disorder of genetic origins, with a heritability of about 90%. Autistic disorder is classed within the broad domain of pervasive developmental disorders (PDD) that also includes Rett syndrome, childhood disintegrative disorder, Asperger syndrome, and PDD not otherwise specified (PDD-NOS). Prevalence estimates suggest a rate of 0.1-0.2% for autism and 0.6% for the range of PDD disorders. There is considerable phenotypic heterogeneity within this class of disorders as well as continued debate regarding their clinical boundaries. Autism is the prototypical PDD, and is characterized by impairments in three core domains: social interaction, language development, and patterns of behavior (restricted and stereotyped). Clinical pattern and severity of impairment vary along these dimensions, and the level of cognitive functioning of individuals with autism spans the entire range, from profound mental retardation to superior intellect. There is no single biological or clinical marker for autism, nor is it expected that a single gene is responsible for its expression; as many as 15+ genes may be involved. However, environmental influences are also important, as concordance in monozygotic twins is less than 100% and the phenotypic expression of the disorder varies widely, even within monozygotic twins. Multiple susceptibility factors are being explored using varied methodologies, including genome-wide linkage studies, and family- and case-control candidate gene association studies. This paper reviews what is currently known about the genetic and environmental risk factors, neuropathology, and psychopharmacology of autism. Discussion of genetic factors focuses on the findings from linkage and association studies, the results of which have implicated the involvement of nearly every chromosome in the human genome. However, the most consistently replicated linkage findings have been on chromosome 7q, 2q, and 15q. The positive associations from candidate gene studies are largely unreplicated, with the possible exceptions of the GABRB3 and serotonin transporter genes. No single region of the brain or pathophysiological mechanism has yet been identified as being associated with autism. Postmortem findings, animal models, and neuroimaging studies have focused on the cerebellum, frontal cortex, hippocampus, and especially the amygdala. The cerebello-thalamo-cortical circuit may also be influential in autism. There is evidence that overall brain size is increased in some individuals with autism. Presently there are no drugs that produce major improvements in the core social or pragmatic language deficits in autism, although several have limited effects on associated behavioral features. The application of new techniques in autism research is being proposed, including the investigation of abnormal regulation of gene expression, proteomics, and the use of MRI and postmortem analysis of the brain.

Neuroanatomical substrates of social cognition dysfunction in autism

In this review article, we summarize recent progress toward understanding the neural structures and circuitry underlying dysfunctional social cognition in autism. We review selected studies from the growing literature that has used the functional neuroimaging techniques of cognitive neuroscience to map out the neuroanatomical substrates of social cognition in autism. We also draw upon functional neuroimaging studies with neurologically normal individuals and individuals with brain lesions to highlight the insights these studies offer that may help elucidate the search for the neural basis of social cognition deficits in autism. We organize this review around key brain structures that have been implicated in the social cognition deficits in autism: (1) the amygdala, (2) the superior temporal sulcus region, and (3) the fusiform gyrus. We review some of what is known about the contribution of each structure to social cognition and then review autism studies that implicate that particular structure. We conclude with a discussion of several potential future directions in the cognitive neuroscience of social deficits in autism.

Deviant gaze processing in children with autism: an ERP study

This study investigated event-related potentials (ERP) during an oddball task in which detection of specific eye direction was required of children with and without autism. The detection of a change in eye direction elicited occipito-temporal negativity, which had two major differences between children with and without autism. First, while this occipito-temporal negativity predominated in the right hemisphere of typically developed children, it was distributed equally bilaterally in children with autism. Second, the amplitude of this negativity was more pronounced in typically developed children in response to the detection of direct gaze as compared to averted gaze, but was not sensitive to direct/averted gaze direction in children with autism, which converges with behavioral reports. The results concur with previous literature, suggesting the importance of the right hemisphere, especially the superior temporal sulcus, in gaze processing. Results indicate that deviant neural substrates might be involved in gaze processing in individuals with autism.

Are Greebles like faces? Using the neuropsychological exception to test the rule

Which image geometries count as face-like and which do not? Across multiple experiments, novel objects called Greebles have been used to argue that face-specific effects can be obtained with non-face stimuli under certain situations, in particular with expert observers. However, this claim depends on the argument that these non-face stimuli are not a priori treated by the face processing system. To address this question, CK, a neuropsychological patient well-known for exhibiting severe visual object agnosia and dyslexia but intact face processing, was tested with Greebles. CK performed poorly on Greebles, indicating that his intact face-specific abilities do not extend to include Greebles. These results suggest that insofar as CK is relying on face-specific visual processes, these processes do not a priori treat Greebles as faces.

Event-related brain potentials reveal anomalies in temporal processing of faces in autism spectrum disorder

BACKGROUND

Individuals with autism exhibit impairments in face recognition, and neuroimaging studies have shown that individuals with autism exhibit abnormal patterns of brain activity during face processing. The current study examined the temporal characteristics of face processing in autism and their relation to behavior.

METHOD

High-density event-related brain potentials (ERPs) were recorded to images of faces, inverted faces, and objects from 9 individuals with autism spectrum disorder (15-42 years old) and 14 typical individuals (16-37 years old).

RESULTS

With respect to a face-sensitive ERP component (N170), individuals with autism exhibited longer N170 latencies to faces than typical individuals but comparable latencies to objects. Typical individuals exhibited longer N170 latencies to inverted as compared to upright faces, whereas individuals with autism did not show differences in N170 latency to upright versus inverted faces. Neural speed of face processing, as reflected in N170 latency, correlated with performance on a face recognition task for individuals with autism.

CONCLUSIONS

These data provide evidence for slowed neural speed of face processing in autism and highlight the role of speed of processing in face processing impairments in autism.

Neuroimaging in disorders of social and emotional functioning: what is the question?

Social and emotional processing uses neural systems involving structures ranging from the brain stem to the associational cortex. Neuroimaging research has attempted to identify abnormalities in components of these systems that would underlie the behavioral abnormalities seen in disorders of social and emotional processing, notably autism spectrum disorders, the focus of this review. However, the findings have been variable. The most replicated anatomic finding (a tendency toward large brains) is not modular, and metabolic imaging and functional imaging (although showing substantial atypicality in activation) are not consistent regarding specific anatomic sites. Moreover, autism spectrum disorder demonstrates substantial heterogeneity on multiple levels. Here evidence is marshaled from a review of neuroimaging data to support the claim that abnormalities in social and emotional processing on the autism spectrum are a consequence of systems disruptions in which the behaviors are a final common pathway and the focal findings can be variable, downstream of other pathogenetic mechanisms, and downstream of more pervasive abnormalities.

Do children with autism perceive second-order relational features? The case of the Thatcher illusion

BACKGROUND

This study presents two experiments that investigated whether children with autism were susceptible to the Thatcher illusion. Perception of the Thatcher illusion requires being able to compute second-order configural relations for facial stimuli.

METHOD

In both experiments children with autism were matched for non-verbal and verbal ability with a group of children with moderate (non-specific) mental retardation (MLD) and a group of typically developing children respectively. Participants were asked to detect the 'unusual' face in a two-alternative-forced-choice version of the Margaret Thatcher illusion with grey-scale (Experiment 1) and monochrome 'Mooney' face images (Experiment 2). In Experiment 1 participants also performed a control task where buildings had been doctored in the same way as the facial stimuli.

RESULTS

Children with autism were as susceptible to the Thatcher illusion as both control groups, in terms of accuracy and reaction time to make decisions about which face was unusual. Children with autism performed more accurately than children with MLD in the buildings task.

CONCLUSION

Children with autism are able to compute second-order configural features in faces and exhibit no difference in face processing, relative to appropriate control groups.

Activation of the fusiform gyrus when individuals with autism spectrum disorder view faces

Prior imaging studies have failed to show activation of the fusiform gyrus in response to emotionally neutral faces in individuals with autism spectrum disorder (ASD) [Critchley et al., Brain 124 (2001) 2059; Schultz et al., Arch. Gen. Psychiatry 57 (2000) 331]. However, individuals with ASD do not typically exhibit the striking behavioral deficits that might be expected to result from fusiform gyrus damage, such as those seen in prosopagnosia, and their deficits appear to extend well beyond face identification to include a wide range of impairments in social perceptual processing. In this study, our goal was to further assess the question of whether individuals with ASD have abnormal fusiform gyrus activation to faces. We used high-field (3 T) functional magnetic resonance imaging to study face perception in 11 adult individuals with autism spectrum disorder (ASD) and 10 normal controls. We used face stimuli, object stimuli, and sensory control stimuli (Fourier scrambled versions of the face and object stimuli) containing a fixation point in the center to ensure that participants were looking at and attending to the images as they were presented. We found that individuals with ASD activated the fusiform face area and other brain areas normally involved in face processing when they viewed faces as compared to non-face stimuli. These data indicate that the face-processing deficits encountered in ASD are not due to a simple dysfunction of the fusiform area, but to more complex anomalies in the distributed network of brain areas involved in social perception and cognition.

A question of balance: a proposal for new mouse models of autism

Autism spectrum disorder (ASD) represents a major mental health problem with estimates of prevalence ranging from 1/500 to 1/2000. While generally recognized as developmental in origin, little to nothing is certain about its etiology. Currently, diagnosis is made on the basis of a variety of early developmental delays and/or regressions in behavior. There are no universally agreed upon changes in brain structure or cell composition. No biomarkers of any type are available to aid or confirm the clinical diagnosis. In addition, while estimates of the heritability of the condition range from 60 to 90%, as of this writing no disease gene has been unequivocally identified. The prevalence of autism is three- to four-fold higher in males than in females, but the reason for this sexual dimorphism is unknown. In light of all of these ambiguities, a proposal to discuss potential animal models may seem the heart of madness. However, parsing autism into its individual genetic, behavioral, and neurobiological components has already facilitated a 'conversation' between the human disease and the neuropathology and biochemistry underlying the disorder. Building on these results, it should be possible to not just replicate one aspect of autism but to connect the developmental abnormalities underlying the ultimate behavioral phenotype. A reciprocal conversation such as this, wherein the human disease informs on how to make a better animal model and the animal model teaches of the biology causal to autism, would be highly beneficial.

Abnormal activity patterns in premotor cortex during sequence learning in autistic patients

BACKGROUND

Evidence for frontal abnormality in autism has accumulated in recent years. Our own studies have shown abnormal activation in prefrontal cortex during finger tapping and visuomotor coordination. Studies in healthy adults suggest reduced premotor and increased prefrontal activity during advanced learning stages. We examined hemodynamic changes during visuomotor learning in autistic patients.

METHODS

We studied eight high-functioning autistic patients and eight control subjects during learning of an 8-digit sequence over a period of 8 min, using functional magnetic resonance imaging.

RESULTS

Autistic patients showed overall less prefrontal activation during late visuomotor learning; however, the main finding was a complementary one of enhanced activation in right pericentral and premotor cortex. In the autism group, Brodmann areas 3, 4, and 6 of the right hemisphere became more involved during late learning stages (trials 25-48), compared with early stages (trials 1-24). This effect was not seen in the control group.

CONCLUSIONS

Our findings suggests that in autistic patients 1) primary sensorimotor and premotor cortex, which is normally predominant in early stages of visuomotor learning, plays an atypical role in later stages, even when learning is evident; and 2) handedness and side of execution interact with asymmetry of visuomotor learning activations, contrary to what is seen in normal adults.

Imaging data in autism: from structure to malfunction

During the last two decades, neuroimaging studies have improved our knowledge of brain development and contributed to our understanding of disorders involving the developing brain. Differences in cerebral anatomy have been determined in autism spectrum disorder (ASD). Morphological studies by magnetic resonance imaging have provided evidence of structural differences in ASD compared with the normal population. This has enhanced our view of autism as a neurobiological disorder corresponding with different stages and events in brain development. Alterations in volume of the total brain and specifically the cerebellum, frontal lobe, and limbic system have been identified. There appears to be a pattern of increased and then decreased rate of brain growth over time. We integrate these observations with neurobehavioral findings to provide a developmental hypothesis of the pathophysiology of autism.

The autistic brain: birth through adulthood

PURPOSE OF REVIEW

We discuss evidence of brain maldevelopment in the first years of life in autism and new neuroanatomical and functional evidence from later ages of development.

RECENT FINDINGS

Head circumference, an accurate indicator of brain size in children, was reported to jump from normal or below normal size in the first postnatal months in autistic infants to the 84 th percentile by about 1 year of age; this abnormally accelerated growth was concluded by 2 years of age. Infants with extreme head (and therefore brain) growth fell into the severe end of the clinical spectrum and had more extreme neuroanatomical abnormalities. In the frontal and temporal lobes in autism, there have been reports of abnormal increases in gray and white matter at 2 to 4 years; reduced metabolic measures; deviant diffusion tensor imaging results in white matter; underdeveloped cortical minicolumns; and reduced functional activation during socio-emotional, cognitive and attention tasks. Cerebellar abnormalities included abnormal volumes, reduced number and size of Purkinje neurons in the vermis and hemispheres, molecular defects, and reduced functional activation in posterior regions.

SUMMARY

A new neurobiological phenomenon in autism has been described that precedes the onset of clinical behavioral symptoms, and is brief and age-delimited to the first two years of life. The neurobiological defects that precede, trigger, and underlie it may form part of the developmental precursors of some of the anatomical, functional, and behavioral manifestations of autism. Future studies of the first years of life may help elucidate the factors and processes that bring about the unfolding of autistic behavior.

Abnormal cortical voice processing in autism

Impairments in social interaction are a key feature of autism and are associated with atypical social information processing. Here we report functional magnetic resonance imaging (fMRI) results showing that individuals with autism failed to activate superior temporal sulcus (STS) voice-selective regions in response to vocal sounds, whereas they showed a normal activation pattern in response to nonvocal sounds. These findings suggest abnormal cortical processing of socially relevant auditory information in autism.

The amygdala is enlarged in children but not adolescents with autism; the hippocampus is enlarged at all ages

Autism is a neurodevelopmental disorder characterized by impairments in reciprocal social interaction, deficits in verbal and nonverbal communication, and a restricted repertoire of activities or interests. We performed a magnetic resonance imaging study to better define the neuropathology of autistic spectrum disorders. Here we report findings on the amygdala and the hippocampal formation. Borders of the amygdala, hippocampus, and cerebrum were defined, and their volumes were measured in male children (7.5-18.5 years of age) in four diagnostic groups: autism with mental retardation, autism without mental retardation, Asperger syndrome, and age-matched typically developing controls. Although there were no differences between groups in terms of total cerebral volume, children with autism (7.5-12.5 years of age) had larger right and left amygdala volumes than control children. There were no differences in amygdala volume between the adolescent groups (12.75-18.5 years of age). Interestingly, the amygdala in typically developing children increases substantially in volume from 7.5 to 18.5 years of age. Thus, the amygdala in children with autism is initially larger, but does not undergo the age-related increase observed in typically developing children. Children with autism, with and without mental retardation, also had a larger right hippocampal volume than typically developing controls, even after controlling for total cerebral volume. Children with autism but without mental retardation also had a larger left hippocampal volume relative to controls. These cross-sectional findings indicate an abnormal program of early amygdala development in autism and an abnormal pattern of hippocampal development that persists through adolescence. The cause of amygdala and hippocampal abnormalities in autism is currently unknown.

Neuropeptides and the social brain: potential rodent models of autism

Conducting basic scientific research on a complex psychiatric disorder, such as autism, is a challenging prospect. It is difficult to dissociate the fundamental neurological and psychological processes that are disturbed in autism and, therefore, it is a challenge to discover accurate and reliable animal models of the disease. Because of their role in animal models of social processing and social bonding, the neuropeptides oxytocin and vasopressin are strong candidates for dysregulation in autism. In this review, we discuss the current animal models which have investigated oxytocin and vasopressin systems in the brain and their effects on social behavior. For example, mice lacking the oxytocin gene have profound deficits in social processing and social recognition, as do rats lacking vasopressin or mice lacking the vasopressin V1a receptor (V1aR). In another rodent model, monogamous prairie voles are highly social and form strong pair bonds with their mates. Pair bonds can be facilitated or disrupted by perturbing the oxytocin and vasopressin systems. Non-monogamous vole species that do not pair bond have different oxytocin and V1aR distribution patterns in the brain than monogamous vole species. Potential ties from these rodent models to the human autistic condition are then discussed. Given the hallmark disturbances in social function, the study of animal models of social behavior may provide novel therapeutic targets for the treatment of autism.

Autism as a disorder of neural information processing: directions for research and targets for therapy

The broad variation in phenotypes and severities within autism spectrum disorders suggests the involvement of multiple predisposing factors, interacting in complex ways with normal developmental courses and gradients. Identification of these factors, and the common developmental path into which they feed, is hampered by the large degrees of convergence from causal factors to altered brain development, and divergence from abnormal brain development into altered cognition and behaviour. Genetic, neurochemical, neuroimaging, and behavioural findings on autism, as well as studies of normal development and of genetic syndromes that share symptoms with autism, offer hypotheses as to the nature of causal factors and their possible effects on the structure and dynamics of neural systems. Such alterations in neural properties may in turn perturb activity-dependent development, giving rise to a complex behavioural syndrome many steps removed from the root causes. Animal models based on genetic, neurochemical, neurophysiological, and behavioural manipulations offer the possibility of exploring these developmental processes in detail, as do human studies addressing endophenotypes beyond the diagnosis itself.

Functional anatomy of impaired selective attention and compensatory processing in autism

In autism, physiological indices of selective attention have been shown to be abnormal even in situations where behaviour is intact. This divergence between behaviour and physiology suggests the action of some compensatory process of attention, one which may hold clues to the aetiology of autism's characteristic cognitive phenotype. Six subjects with autism spectrum disorders and six normal control subjects were studied with functional magnetic resonance imaging while performing a bilateral visual spatial attention task. In normal subjects, the task evoked activation in a network of cortical regions including the superior parietal lobe (P<0.001), left middle temporal gyrus (P=0.002), left inferior (P<0.001) and middle (P<0.02) frontal gyri, and medial frontal gyrus (P<0.02). Autistic subjects, in contrast, showed activation in the bilateral ventral occipital cortex (P<0.03) and striate cortex (P<0.05). Within the task condition, a region-of-interest comparison of attend-left versus attend-right conditions indicated that modulation of activation in the autistic brain as a function of the lateral focus of spatial attention was abnormally decreased in the left ventral occipital cortex (P<0.03), abnormally increased in the left intraparietal sulcus (P<0.01), and abnormally variable in the superior parietal lobe (P<0.03). These results are discussed in terms of a model of autism in which a pervasive defect of neural and synaptic development produces over-connected neural systems prone to noise and crosstalk, resulting in hyper-arousal and reduced selectivity. These low-level attentional traits may be the developmental basis for higher-order cognitive styles such as weak central coherence.