Current directions in research on autism

The Simultaneous Assessment of Time and Motion Response during Dual Tasks

Measurement of reaction time in clinical settings is generally employed to assess cognitive abilities by having a subject perform standard simple tests. In this study, a new method of measuring response time (RT) was developed using a system composed of LEDs that emit light stimuli and are equipped with proximity sensors. The RT is measured as the time taken by the subject to turn off the LED target by moving the hand towards the sensor. Through an optoelectronic passive marker system, the associated motion response is assessed. Two tasks of 10 stimuli each were defined: simple reaction time and recognition reaction time tasks. To validate the method implemented to measure RTs, the reproducibility and repeatability of the measurements were estimated, and, to test the method's applicability, a pilot study was conducted on 10 healthy subjects (6 females and 4 males, age = 25 ± 2 years), reporting, as expected, that the response time was affected by the task's difficulty. Unlike commonly used tests, the developed method has proven to be adequate for the simultaneous evaluation of the response in terms of time and motion. Furthermore, thanks to the playful nature of the tests, this method could also be used for clinical and pediatric applications to measure the impact of motor and cognitive impairments on RT.

Mismatch Negativity and Auditory Brain Stem Response in Children with Autism Spectrum Disorders and Language Disorders

Objective

Language disorders (LD) in autism spectrum disorders (ASD) are highly variable and has a severe impact on the level of functioning in autistic children. Early diagnosis of these language disorders is essential for early interventions for children at risk. The electrophysiological measurements are considered valuable tools for determining language disabilities in children with ASD. This study aimed to study and compare ABR and MMN in autistic children with language disorders.

Methods

This study included a group of typically developing children and a group of children diagnosed with autistic spectrum disorders and language disorders. Both groups were matching according to age and gender. After confirming bilateral normal peripheral hearing sensitivity, ABR was done and both absolute and interpeak wave latencies were correlated. MMN using frequency oddball paradigms were also obtained and correlated.

Results

More abnormalities were reported in ABR test results in the form of delayed absolute latencies and prolonged interpeak intervals. Also, we reported prolonged latencies of MMN. Consequently, both ABR and MMN are complementary test in evaluating autistic children with language disorders.

Conclusion

Our results support the hypothesis of remarkable dysfunction in basic auditory sound processing that may impact the linguistic development of autistic children.

Lexical Alignment and Communicative Success in Autism Spectrum Disorder

PURPOSE

Typical speakers tend to adopt words used by their conversational partners. This "lexical alignment" enhances communication by reducing ambiguity and promoting a shared understanding of the topic under discussion. Lexical alignment has been little studied to date in autism spectrum disorder (ASD); furthermore, it has been studied primarily via structured laboratory tasks that may overestimate performance. This study examined lexical alignment in ASD during discourse and explored associations with communicative success and executive function.

METHOD

Thirty-one autistic and nonautistic adolescents were paired with a study-naïve research assistant (RA) to complete a social communication task that involved taking turns verbally instructing (guiding) the partner to navigate on a map. Lexical alignment was operationalized as the proportion of shared vocabulary produced by guides on successive maps. Task accuracy was operationalized as the pixels contained within the intended and drawn routes.

RESULTS

Results indicated that autistic adolescents had greater difficulty describing navigational routes to RAs, yielding paths that were less accurate. Alignment was reduced in autistic participants, and it was associated with path accuracy for nonautistic, but not autistic, adolescents. The association between lexical alignment and executive function missed significance (p = .05); if significant, the association would indicate that greater executive function difficulty was associated with reduced lexical alignment.

CONCLUSIONS

These findings provide preliminary evidence of reduced lexical alignment in ASD in an unstructured discourse context. Moreover, positive associations between lexical alignment and task performance in the neurotypical group raise the possibility that interventions to promote the use of shared vocabulary might support better communication.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21313719.

Shisa7 phosphorylation regulates GABAergic transmission and neurodevelopmental behaviors

GABA-A receptors (GABAARs) are crucial for development and function of the brain. Altered GABAergic transmission is hypothesized to be involved in neurodevelopmental disorders. Recently, we identified Shisa7 as a GABAAR auxiliary subunit that modulates GABAAR trafficking and GABAergic transmission. However, the underlying molecular mechanisms remain elusive. Here we generated a knock-in (KI) mouse line that is phospho-deficient at a phosphorylation site in Shisa7 (S405) and combined with electrophysiology, imaging and behavioral assays to illustrate the role of this site in GABAergic transmission and plasticity as well as behaviors. We found that expression of phospho-deficient mutants diminished α2-GABAAR trafficking in heterologous cells. Additionally, α1/α2/α5-GABAAR surface expression and GABAergic inhibition were decreased in hippocampal neurons in KI mice. Moreover, chemically induced inhibitory long-term potentiation was abolished in KI mice. Lastly, KI mice exhibited hyperactivity, increased grooming and impaired sleep homeostasis. Collectively, our study reveals a phosphorylation site critical for Shisa7-dependent GABAARs trafficking which contributes to behavioral endophenotypes displayed in neurodevelopmental disorders.

Parent-mediated play‐based interventions to improve social communication and language skills of preschool autistic children: A systematic review and meta-analysis protocol

Early years interventions have shown to be effective in improving the social communication and language skills of autistic children. Therefore, various play-based interventions have been developed to support those developmental areas of autistic children. Although researchers have previously reported the overall effectiveness of different types of play-based interventions on the social communication and language skills of autistic children, no previous systematic reviews have yet evaluated the effectiveness of parent-mediated play-based interventions in preschool autistic children. The overarching aims of the study will be to (i) report the key characteristics and (ii) synthesise the results of studies evaluating parent-mediated play-based interventions targeting the social communication and language skills of preschool autistic children using experimental designs. A comprehensive search for and screening of the relevant studies published between 2000 and 2021 will be undertaken. To be included, studies will have to (i) use either a randomised control trial or quasi-experimental design, (ii) focus on preschool autistic children aged six years old or younger, (iii) deliver a play-based intervention in non-educational settings, and (iv) include at least one parent as the mediator of the intervention. Data extraction of all included studies will be undertaken using a specially devised template and they will also be assessed for risk of bias using an adapted form from the Cochrane Risk of Bias tool. The overall characteristics of the included studies will be reported and a narrative synthesis of the results of the included studies will be undertaken. A meta-analysis may be performed (if justified) to report the pooled effect size of the parent-mediated play-based interventions on the social communication and language skills of preschool autistic children.

Trial registration: The current study protocol was pre-registered with the international prospective register of systematic reviews (PROSPERO: CRD42022302220).

TCHis mitigate oxidative stress and improve abnormal behavior in a prenatal valproic acid-exposed rat model of autism

Objective Troxerutin is known for its anti-inflammatory and antioxidative effects in nerve impairment. The purpose of this study is to investigate the effect of troxerutin and cerebroprotein hydrolysate injections (TCHis) on prenatal valproic acid (VPA)-exposed rats. Methods The VPA was administered to pregnant rats on gestational day 12.5 to induce a model of autism. The offsprings were given the treatment of TCHis on postnatal day (PND) 21-50. On PND 43-50, the behavioral analysis of offsprings was performed after the treatment of TCHis for 1 h. On PND 50, the offsprings were harvested and the brains were collected. The hippocampus and prefrontal cortex were isolated for relevant biochemical detections. Results The administration of TCHis increased the pain sensitivity and improved abnormal social behaviors in prenatal VPA-exposed rats. Prenatal expose of VPA induced neuronal loss and apoptosis, enhanced reactive oxygen species (ROS) production, and promoted oxidative stress in hippocampus and prefrontal cortex, while these effects were reversed by the postnatal treatment of TCHis. In addition, postnatal administration of TCHis ameliorated mitochondrial function in hippocampus and prefrontal cortex of prenatal VPA-exposed rats. Conclusion This study concluded that postnatal treatment of TCHis reduced oxidative stress and ameliorated abnormal behavior in a prenatal VPA-induced rat model of autism.

Potential scalp stimulation targets for mental disorders: evidence from neuroimaging studies

Mental disorders widely contribute to the modern global disease burden, creating a significant need for improvement of treatments. Scalp stimulation methods (such as scalp acupuncture and transcranial electrical stimulation) have shown promising results in relieving psychiatric symptoms. However, neuroimaging findings haven’t been well-integrated into scalp stimulation treatments. Identifying surface brain regions associated with mental disorders would expand target selection and the potential for these interventions as treatments for mental disorders. In this study, we performed large-scale meta-analyses separately on eight common mental disorders: attention deficit hyperactivity disorder, anxiety disorder, autism spectrum disorder, bipolar disorder, compulsive disorder, major depression, post-traumatic stress disorder and schizophrenia; utilizing modern neuroimaging literature to summarize disorder-associated surface brain regions, and proposed neuroimaging-based target protocols. We found that the medial frontal gyrus, the supplementary motor area, and the dorsal lateral prefrontal cortex are commonly involved in the pathophysiology of mental disorders. The target protocols we proposed may provide new brain targets for scalp stimulation in the treatment of mental disorders, and facilitate its clinical application.

Major motor and gait deficits with sexual dimorphism in a Shank3 mutant mouse model

Background

Contrasting findings were reported in several animal models with a Shank3 mutation used to induce various autism spectrum disorder (ASD) symptoms. Here, we aimed at investigating behavioral, cellular, and molecular consequences of a C-terminal (frameshift in exon 21) deletion in Shank3 protein in mice, a mutation that is also found in clinical conditions and which results in loss of major isoforms of Shank3. A special focus was made on cerebellar related parameters.

Methods

All three genotypes were analyzed [wild type (WT), heterozygote (Shank3+/ΔC) and homozygote (Shank3 ΔC/ΔC)] and males and females were separated into two distinct groups. Motor and social behavior, gait, Purkinje cells (PC) and glutamatergic protein levels were determined. Behavioral and cellular procedures used here were previously validated using two environmental animal models of ASD. ANOVA and post-hoc analysis were used for statistical analysis.

Results

Shank3 ΔC/ΔC mice showed significant impairments in social novelty preference, stereotyped behavior and gait. These were accompanied by a decreased number of PC in restricted cerebellar sub-regions and decreased cerebellar expression of mGluR5. Females Shank3 ΔC/ΔC were less affected by the mutation than males. Shank3+/ΔC mice showed impairments only in social novelty preference, grooming, and decreased mGluR5 expression and that were to a much lesser extent than in Shank3 ΔC/ΔC mice.

Limitations

As Shank3 mutation is a haploinsufficiency, it is of interest to emphasize that Shank3+/ΔC mice showed only mild to no deficiencies compared to Shank3 ΔC/ΔC.

Conclusions

Our findings indicate that several behavioral, cellular, and molecular parameters are affected in this animal model. The reported deficits are more pronounced in males than in females. Additionally, male Shank3 ΔC/ΔC mice show more pronounced alterations than Shank3+/ΔC. Together with our previous findings in two environmental animal models of ASD, our studies indicate that gait dysfunction constitutes a robust set of motor ASD symptoms that may be considered for implementation in clinical settings as an early and quantitative diagnosis criteria.

Brief Report: Analysis of the Relationship Between Turn Taking and Joint Attention for Toddlers with Autism

The relationship between turn taking (i.e., back-and-forth preverbal communicative exchanges) and joint attention has not been studied in interactions between children with autism and caregivers. In joint attention, a form of preverbal social communication, young children socially share attention with a partner about objects, a competency that is difficult for toddlers with autism. Video data of interactions between caregivers and 61 toddlers with autism who received joint attention-focused intervention were analyzed to determine associations between turn taking and joint attention. Results indicate a positive relationship between the two forms of social communication. Further study is needed to determine the extent to which turn taking may play a foundational role in supporting joint attention development for toddlers with autism.

Impact of Family-Centered Early Intervention in Infants with Autism Spectrum Disorder: A Single-Subject Design

Objective

Autism spectrum disorder is a neurodevelopmental disorder that affects communication, social skills, and behavior and can present in early childhood. The present study is aimed at investigating the effects of family-centered early intervention on the quality of social interaction and social interaction skills in infants with suspected autism spectrum disorder using a single-subject design.

Method

As a single-subject design study, evaluations were conducted at baseline phase A, intervention phase B, baseline phase A', and follow-up phase. The family-centered early intervention program was implemented during the intervention phase. Family-centered early intervention programs included home environmental modification, play video recording and training, task and feedback, related information training, and question and answer. The Modified Checklist for Autism in Toddlers, Revised, with Follow-Up and Evaluation of Social Interaction was used for evaluation.

Result

Three participants completed the study. After applying the family-centered early intervention program, the quality of social interaction and social interaction skills of all participants improved. In addition, the risk of autism spectrum disorder in all participants was reduced.

Conclusion

Family-centered early intervention was confirmed to have a positive effect on the improvement of social interaction skills in infants with suspected autism spectrum disorder.

Factually based autism awareness campaigns may not always be effective in changing attitudes towards autism: Evidence from British and South Korean nursing students

This study explored the relationship between autism knowledge, autistic traits, frequency of contact with autistic people and attitudes towards these individuals in British and South Korean student nurses and whether these relationships were affected by the presence of autistic traits. In total, 331 participants (156 South Korean and 175 British) completed self-report measures of autism knowledge, attitudes towards autistic people, frequency of contact with these individuals and autistic traits. Although British participants demonstrated greater knowledge and more favourable attitudes, significant knowledge deficiencies were noted in both groups. Among British participants, knowledge was found to be a significant, but a very marginal, predictor of attitudes, whereas neither knowledge nor frequency of contact were predictive of attitudes among South Korean participants. Contrary to previous research findings, cultural differences in the presence of autistic traits were not noted, nor were these traits found to correlate with attitudes towards autistic people. The findings suggest that awareness initiatives which aim to address attitudes towards autism need more than simply increasing factual knowledge. More importantly, the results suggest that Western-developed autism awareness initiatives may be ineffectual if cultural idiosyncrasies are not considered.

Lay abstract

This study explored the relationship between autism knowledge, autistic traits, frequency of contact with autistic people and attitudes towards these individuals in British and South Korean student nurses and whether these relationships were affected by the presence of autistic traits. In total, 331 participants (156 South Korean and 175 British) completed self-report measures of autism knowledge, attitudes towards autistic people, frequency of contact with these individuals and autistic traits. Although British participants demonstrated greater knowledge and more favourable attitudes, significant knowledge gaps were noted in both groups. Among British participants, knowledge was found to be only a marginal predictor of attitudes, whereas neither knowledge nor frequency of contact were predictive of attitudes among South Korean participants. Contrary to previous research findings, cultural differences in the presence of autistic traits were not noted, nor were these traits found to be related to attitudes towards autistic people. The findings suggest that awareness initiatives which aim to address attitudes towards autism need more than simply increasing factual knowledge. More importantly, the results suggest that Western-developed autism awareness initiatives may be ineffectual if cultural differences are not considered.

Using Visual Supports to Facilitate Audiological Testing for Children With Autism Spectrum Disorder

Purpose One in 59 children is diagnosed with autism spectrum disorder (ASD). Due to overlapping symptoms between hearing loss and ASD, children who are suspected of having ASD require an audiological evaluation to determine their hearing status for the purpose of differential diagnosis. The purpose of this article is twofold: (a) to increase audiologists' knowledge of ASD by discussing the challenges associated with testing and interpreting clinical data for children with ASD or suspected ASD and (b) to provide visual supports that can be used to facilitate audiological assessment. Method Eight children (ages 4-12 years) were recruited as video model participants. Videos were filmed using scripts that used concise and concrete language while portraying common clinical procedures. Using the video models, corresponding visual schedules were also created. Conclusion Although obtaining reliable hearing data from children with ASD is challenging, incorporating visual supports may facilitate testing. Video models and visual schedules have been created and made freely available for download online under a Creative Commons License (Creative Commons-Attribution-NonCommercial-ShareAlike 4.0 International License). Incorporating visual supports during clinical testing has the potential to reduce the child's and family's stress, as well as to increase the probability of obtaining a reliable and comprehensive audiological evaluation. Future research is warranted to determine the effectiveness and feasibility of implementing these tools in audiology clinics. Supplemental Material https://doi.org/10.23641/asha.10086434.

Neural correlates of association strength and categorical relatedness in youths with autism spectrum disorder

Impaired language and communication are commonly observed in youths with autism spectrum disorders (ASDs). However, the organization of semantic knowledge in youths with ASD remains unclear compared to typically developing (TD) youths. The present study addresses this issue by using functional magnetic resonance imaging (fMRI) to examine the distinction between association strength and categorical relatedness of semantic knowledge. A sample of 31 male youths with ASD (mean age = 12.1 years, SD = 1.2) and 38 TD youths (mean age = 11.9 years, SD = 1.0) was recruited with matched age, gender, and handedness. Participants decided if two visually presented Chinese characters were semantically related during fMRI scanning. For weaker association strength, the ASD group showed greater left cuneus activation, which was positively correlated with the picture completion for visual perception, whereas the TD group showed greater middle temporal gyrus and inferior frontal gyrus activation. For higher categorical relatedness, the TD group showed greater activation than the ASD group in the occipitotemporal cortex and left precuneus, which was positively correlated with the similarities for concept formulation. Findings imply that the ASD group may use lower-level visual information for both association strength and categorical relatedness. The TD group showed higher-level controlled processes of more elaborate semantic representations for association strength and more elaborate features of categorical knowledge for semantic selection and integration. Autism Res 2019, 12: 1484-1494. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Individuals with autism spectrum disorder (ASD) often present language/communication impairments. Exploring the difference of semantic processing between youths with ASD and typically developing (TD) youths is crucial for understanding the organization of semantic knowledge. We found different neural substrates of semantic knowledge between these two groups. ASD youths may rely more on lower-level visual information during semantic judgments, whereas TD youths showed higher-level controlled processes of more elaborate semantic representations for selection and integration of words, phrases, and sentences.

A Spectrotemporal Correlate of Language Impairment in Autism Spectrum Disorder

This study introduces an objective neurophysiological marker of language ability, the integral of event-related desynchronization in the 5-20 Hz band during 0.2-1 seconds post auditory stimulation with interleaved word/non-word tokens. This measure correlates with clinical assessment of language function in both ASD and neurotypical pediatric populations. The measure does not appear related to general cognitive ability nor autism symptom severity (beyond degree of language impairment). We suggest that this oscillatory brain activity indexes lexical search and thus increases with increased search in the mental lexicon. While specificity for language impairment in ASD remains to be determined, such an objective index has potential utility in low functioning individuals with ASD and young children during language acquisition.

Altered human voice processing in the frontal cortex and a developmental language delay in 3- to 5-year-old children with autism spectrum disorder

The inferior frontal and superior temporal areas in the left hemisphere are crucial for human language processing. In the present study, we investigated the magnetic mismatch field (MMF) evoked by voice stimuli in 3- to 5-year-old typically developing (TD) children and children with autism spectrum disorder (ASD) using child-customized magnetoencephalography (MEG). The children with ASD exhibited significantly decreased activation in the left superior temporal gyrus compared with the TD children for the MMF amplitude. If we classified the children with ASD according to the presence of a speech onset delay (ASD - SOD and ASD - NoSOD, respectively) and compared them with the TD children, both ASD groups exhibited decreased activation in the left superior temporal gyrus compared with the TD children. In contrast, the ASD - SOD group exhibited increased activity in the left frontal cortex (i.e., pars orbitalis) compared with the other groups. For all children with ASD, there was a significant negative correlation between the MMF amplitude in the left pars orbitalis and language performance. This investigation is the first to show a significant difference in two distinct MMF regions in ASD – SOD children compared with TD children.

Cochlear implantation in autistic children with profound sensorineural hearing loss

INTRODUCTION

Cochlear implants have become the method of choice for the treatment of severe-to-profound hearing loss in both children and adults. Its benefits are well documented in the pediatric and adult population. Also deaf children with additional needs, including autism, have been covered by this treatment.

OBJECTIVE

The aim of this study was to assess the benefits from cochlear implantation in deafened children with autism as the only additional disability.

METHODS

This study analyzes data of six children. The follow-up time was at least 43 months. The following data were analyzed: medical history, reaction to music and sound, Ling's six sounds test, onomatopoeic word test, reaction to spoken child's name, response to requests, questionnaire given to parents, sound processor fitting sessions and data.

RESULTS

After cochlear implantation each child presented other communication skills. In some children, the symptoms of speech understanding were observed. No increased hyperactivity associated with daily use cochlear implant was observed. The study showed that in autistic children the perception is very important for a child's sense of security and makes contact with parents easier.

CONCLUSION

Our study showed that oral communication is not likely to be a realistic goal in children with cochlear implants and autism. The implantation results showed benefits that varied among those children. The traditional methods of evaluating the results of cochlear implantation in children with autism are usually insufficient to fully assess the functional benefits. These benefits should be assessed in a more comprehensive manner taking into account the limitations of communication resulting from the essence of autism. It is important that we share knowledge about these complex children with cochlear implants.

Systematic review of the effectiveness of pharmacological treatments for adolescents and adults with autism spectrum disorder

The variable expression of autism over the lifespan is likely to lead to different symptoms and support requirements, and to distinct responses to pharmacotherapy treatment, in older patients compared to children. This systematic review considers the effectiveness of pharmacological treatment in managing autism spectrum disorder in adolescents and adults. Following a comprehensive search of literature published in English from 1980, methodological criteria were applied to identify studies designed to reliably assess treatment effectiveness. Only five double-blind, randomized controlled trials were eligible for appraisal. All had small sample sizes (mean = 30) and brief treatment duration of no more than 12 weeks. The paucity of trials and their methodological limitations means that there is only preliminary evidence about the short-term effectiveness of a few drug treatments for this age group. There was also a lack of reliable data reported on drug safety profiles. Methodological challenges and directions for future research are discussed.

Story Goodness in Adolescents With Autism Spectrum Disorder (ASD) and in Optimal Outcomes From ASD

PURPOSE

This study examined narrative quality of adolescents with autism spectrum disorder (ASD) using a well-studied "story goodness" coding system.

METHOD

Narrative samples were analyzed for distinct aspects of story goodness and rated by naïve readers on dimensions of story goodness, accuracy, cohesiveness, and oddness. Adolescents with high-functioning ASD were compared with adolescents with typical development (TD; n = 15 per group). A second study compared narratives from adolescents across three groups: ASD, TD, and youths with "optimal outcomes," who were diagnosed with ASD early in development but no longer meet criteria for ASD and have typical behavioral functioning.

RESULTS

In both studies, the ASD group's narratives had lower composite quality scores compared with peers with typical development. In Study 2, narratives from the optimal outcomes group were intermediate in scores and did not differ significantly from those of either other group. However, naïve raters were able to detect qualitative narrative differences across groups.

CONCLUSIONS

Findings indicate that pragmatic deficits in ASD are salient and could have clinical relevance. Furthermore, results indicate subtle differences in pragmatic language skills for individuals with optimal outcomes despite otherwise typical language skills in other domains. These results highlight the need for clinical interventions tailored to the specific deficits of these populations.

Theory of mind and empathy in preclinical and clinical Huntington's disease

We investigated cognitive and affective Theory of Mind (ToM) and empathy in patients with premanifest and manifest Huntington's disease (HD). The relationship between ToM performance and executive skills was also examined. Sixteen preclinical and 23 clinical HD patients, and 39 healthy subjects divided into 2 control groups were given a French adaptation of the Yoni test (Shamay-Tsoory, S.G., Aharon-Peretz, J. (2007). Dissociable prefrontal networks for cognitive and affective theory of mind: a lesion study. Neuropsychologia, 45(3), 3054-67) that examines first- and second-order cognitive and affective ToM processing in separate conditions with a physical control condition. Participants were also given questionnaires of empathy and cognitive tests which mainly assessed executive functions (inhibition and mental flexibility). Clinical HD patients made significantly more errors than their controls in the first- and second-order cognitive and affective ToM conditions of the Yoni task, but exhibited no empathy deficits. However, there was no evidence that ToM impairment was related to cognitive deficits in these patients. Preclinical HD patients were unimpaired in ToM tasks and empathy measures compared with their controls. Our results are consistent with the idea that impaired affective and cognitive mentalizing emerges with the clinical manifestation of HD, but is not necessarily part of the preclinical stage. Furthermore, these impairments appear independent of executive dysfunction and empathy.

Peer-mediated intervention for pre-schoolers with ASD: Effects on responses and initiations

PURPOSE

This study investigates the effects of peer-mediated intervention on the responses and initiations of pre-schoolers (aged 4;2-5;1) with Autism Spectrum Disorder (ASD).

METHOD

A speech-language pathologist and three early childhood educators trained typically-developing peers to facilitate responses and initiations from three pre-schoolers with ASD during playtime. A multiple baseline design across subjects was used to determine the effects of the intervention. Play sessions between the children with ASD and their typically-developing peers were videotaped. Videotapes were analysed using an interval coding system in order to collect information regarding responses and initiations.

RESULT

All three target children demonstrated improvements in their responses and initiations to their peers during intervention. Moreover, they maintained these gains 4 weeks later and generalized their response and initiation skills to an untrained peer. Social validity data, obtained using unbiased, independent, lay, observers to rate the children's performance provided external validation of an observable treatment effect (i.e. increased responses and initiations) following intervention.

CONCLUSION

The results suggest that training typically-developing peers to implement intervention strategies using the collaboration between a speech-language pathologist and early childhood educators may be an effective model of service delivery to enhance peer interaction skills of pre-schoolers with ASD.

Ionotropic GABA and Glutamate Receptor Mutations and Human Neurologic Diseases

The advent of whole exome/genome sequencing and the technology-driven reduction in the cost of next-generation sequencing as well as the introduction of diagnostic-targeted sequencing chips have resulted in an unprecedented volume of data directly linking patient genomic variability to disorders of the brain. This information has the potential to transform our understanding of neurologic disorders by improving diagnoses, illuminating the molecular heterogeneity underlying diseases, and identifying new targets for therapeutic treatment. There is a strong history of mutations in GABA receptor genes being involved in neurologic diseases, particularly the epilepsies. In addition, a substantial number of variants and mutations have been found in GABA receptor genes in patients with autism, schizophrenia, and addiction, suggesting potential links between the GABA receptors and these conditions. A new and unexpected outcome from sequencing efforts has been the surprising number of mutations found in glutamate receptor subunits, with the GRIN2A gene encoding the GluN2A N-methyl-d-aspartate receptor subunit being most often affected. These mutations are associated with multiple neurologic conditions, for which seizure disorders comprise the largest group. The GluN2A subunit appears to be a locus for epilepsy, which holds important therapeutic implications. Virtually all α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor mutations, most of which occur within GRIA3, are from patients with intellectual disabilities, suggesting a link to this condition. Similarly, the most common phenotype for kainate receptor variants is intellectual disability. Herein, we summarize the current understanding of disease-associated mutations in ionotropic GABA and glutamate receptor families, and discuss implications regarding the identification of human mutations and treatment of neurologic diseases.

Perceived self-efficacy in parents of adolescents and adults with autism spectrum disorder

Many parents of adolescents and adults with autism spectrum disorder experience difficulty accessing appropriate services for their children, and may report low levels of parent self-efficacy. In an effort to identify the factors that contribute to the difficulties these families face, this study examined the role of demographic, systemic, and clinical need variables as they relate to parents' experience of self-efficacy. Participants included 324 parents of individuals with autism spectrum disorder, 12-25 years of age. Results suggest that parent self-efficacy is related to a number of variables and not simply a child's clinical situation, including child age, parent immigrant status, barriers to service access, and caregiver burden. Given the crucial role that parents often play in the lives of individuals with autism spectrum disorder across the lifespan, it is important that service providers support the efforts of parents who provide and access care for their children.

Brief report: the smiles of a child with autism spectrum disorder during an animal-assisted activity may facilitate social positive behaviors--quantitative analysis with smile-detecting interface

We quantitatively measured the smiles of a child with autism spectrum disorder (ASD-C) using a wearable interface device during animal-assisted activities (AAA) for 7 months, and compared the results with a control of the same age. The participant was a 10-year-old boy with ASD, and a normal healthy boy of the same age was the control. They voluntarily participated in this study. Neither child had difficulty putting on the wearable device. They kept putting on the device comfortably through the entire experiment (duration of a session was about 30-40 min). This study was approved by the Ethical Committee based on the rules established by the Institute for Developmental Research, Aichi Human Service Center. The behavior of the participants during AAA was video-recorded and coded by the medical examiner (ME). In both groups, the smiles recognized by the ME corresponded with the computer-detected smiles. In both groups, positive social behaviors increased when the smiles increased. Also, negative social behaviors decreased when the smiles increased in the (ASD-C). It is suggested that by leading the (ASD-C) into a social environment that may cause smiling, the child's social positive behaviors may be facilitated and his social negative behaviors may be decreased.

The role of supported joint engagement and parent utterances in language and social communication development in children with autism spectrum disorder

This study examined associations between three parent–child engagement states and social communication, expressive language, and receptive language at 8 month follow-up, in 63 preschool-age children with autism spectrum disorder. We extend the literature on supported joint engagement by dividing this state into higher order (HSJE) and lower order types, with HSJE involving greater reciprocity in toy play. We also examined parents’ follow-in utterances that co-occurred with each state. We found that only HSJE predicts later social communication and expressive language, while object engagement predicts receptive language. HSJE combined with follow-in utterances (HSJE+FI) predicts all three outcomes when controlling for HSJE+FI in other engagement states. When controlling for total HSJE, HSJE+FI is predictive of receptive language.

The contribution of two categories of parent verbal responsiveness to later language for toddlers and preschoolers on the autism spectrum

PURPOSE

The authors examined longitudinal associations between 2 categories of parent verbal responsiveness and language comprehension and production 1 year later in 40 toddlers and preschoolers with a diagnosis of an autism spectrum disorder (ASD).

METHOD

Parent-child play samples using a standard toy set were digitally captured and coded for child engagement with objects and communication acts and for parent verbal responses to play and communication.

RESULTS

After controlling for parent education, child engagement, and initial language level, only parent directives for language that followed into the child's focus of attention accounted for unique variance in predicting both comprehension and production 1 year later. A series of exploratory analyses revealed that parent comments that followed into the child's focus of attention also accounted for unique variance in later comprehension and production for children who were minimally verbal at the initial time period.

CONCLUSIONS

Child developmental level may warrant different types of linguistic input to facilitate language learning. Children with ASD who have minimal linguistic skills may benefit from parent language input that follows into the child's focus of attention. Children with ASD who are verbally fluent may need more advanced language input to facilitate language development.

Atypical Neural Processing of Ironic and Sincere Remarks in Children and Adolescents with Autism Spectrum Disorders

Individuals with ASD show consistent impairment in processing pragmatic language when attention to multiple social cues (e.g., facial expression, tone of voice) is often needed to navigate social interactions. Building upon prior fMRI work examining how facial affect and prosodic cues are used to infer a speaker's communicative intent, the authors examined whether children and adolescents with ASD differ from typically developing (TD) controls in their processing of sincere versus ironic remarks. At the behavioral level, children and adolescents with ASD and matched TD controls were able to determine whether a speaker's remark was sincere or ironic equally well, with both groups showing longer response times for ironic remarks. At the neural level, for both sincere and ironic scenarios, an extended cortical network-including canonical language areas in the left hemisphere and their right hemisphere counterparts-was activated in both groups, albeit to a lesser degree in the ASD sample. Despite overall similar patterns of activity observed for the two conditions in both groups, significant modulation of activity was detected when directly comparing sincere and ironic scenarios within and between groups. While both TD and ASD groups showed significantly greater activity in several nodes of this extended network when processing ironic versus sincere remarks, increased activity was largely confined to left language areas in TD controls, whereas the ASD sample showed a more bilateral activation profile which included both language and "theory of mind" areas (i.e., ventromedial prefrontal cortex). These findings suggest that, for high-functioning individuals with ASD, increased activity in right hemisphere homologues of language areas in the left hemisphere, as well as regions involved in social cognition, may reflect compensatory mechanisms supporting normative behavioral task performance.

[Psychotherapy of Asperger syndrome in adults]

There is an increase in awareness in professionals that the Asperger syndrome (AS) in adulthood is associated with specific problems and burdens which may well differ from those in childhood and adolescence. The core symptoms of AS generally persist into adulthood, however in contrast to childhood and adolescence there is no specific support system for adults in Germany. Also the environment of the afflicted patient changes thus producing different challenges and problems. In addition a subgroup of patients with high functioning AS primarily presents in adulthood generally due to secondary psychosocial problems, depression or anxiety. Difficulties in social interaction, problems with modified daily routines and unforeseen situations cause severe frustration for the majority of the patients. While several therapy programs have been developed and implemented for children and adolescents, for adults there are none. Also there is a lack of comprehensive concepts addressing the specific needs of adult patients with AS. From an economic perspective this is particularly unfortunate since affected people often have good or excellent partial abilities and might be very valuable employees. In this article existing therapeutic concepts for AS are summarized and a newly designed group therapy program for adult patients with Asperger syndrome in Freiburg is introduced (Freiburg Asperger-spezifische Therapie für Erwachsene, FASTER) which specifically addresses the needs and problems of adult patients with AS.

[Brain imaging in autism spectrum disorders. A review]

In the past two decades, an increasing number of functional and structural brain imaging studies has provided insights into the neurobiological basis of autism spectrum disorders (ASD). This article summarizes pertinent functional brain imaging studies addressing the neuronal underpinnings of ASD symptomatology (impairments in social interaction and communication, repetitive and restrictive behavior) and associated neuropsychological deficits (theory of mind, executive functions, central coherence), complemented by relevant structural imaging findings. The results of these studies show that although cognitive functions in ASD are generally mediated by the same brain regions as in typically developed individuals, the degree and especially the patterns of brain activation often differ. Therefore, a hypothesis of aberrant network connectivity has increasingly been favored over one of focal brain dysfunction.

Auditory magnetic mismatch field latency: a biomarker for language impairment in autism

BACKGROUND

Auditory processing abnormalities are frequently observed in autism spectrum disorders (ASD), and these abnormalities may have sequelae in terms of clinical language impairment (LI). The present study assessed associations between language impairment and the amplitude and latency of the superior temporal gyrus magnetic mismatch field (MMF) in response to changes in an auditory stream of tones or vowels.

METHODS

Fifty-one children with ASD, and 27 neurotypical control subjects, all aged 6 to 15 years, underwent neuropsychological evaluation, including tests of language function, as well as magnetoencephalographic recording during presentation of tones and vowels. The MMF was identified in the difference waveform obtained from subtraction of responses to standard from deviant stimuli.

RESULTS

Magnetic mismatch field latency was significantly prolonged (p < .001) in children with ASD, compared with neurotypical control subjects. Furthermore, this delay was most pronounced (∼50 msec) in children with concomitant LI, with significant differences in latency between children with ASD with LI and those without (p < .01). Receiver operator characteristic analysis indicated a sensitivity of 82.4% and specificity of 71.2% for diagnosing LI based on MMF latency.

CONCLUSIONS

Neural correlates of auditory change detection (the MMF) are significantly delayed in children with ASD, and especially those with concomitant LI, suggesting a neurobiological basis as well as a clinical biomarker for LI in ASD.

Developmental surveillance of infants and toddlers by maternal and child health nurses in an Australian community-based setting: promoting the early identification of autism spectrum disorders

Although signs of autism spectrum disorders (ASDs) are evident during the first year of life, few children are diagnosed prior to 3 years. The objective in this article is to highlight the role that primary health care professionals can play in the early identification of ASDs by briefly outlining the successful implementation of The Social Attention and Communication Study. Maternal and child health nurses were trained on the early signs of ASDs, which enabled them to identify these children prior to 2 years. The training procedure used will be outlined, and the early signs that were monitored will be explained in detail. It is recommended that routine monitoring for ASDs in infancy and toddlerhood become standard practice among all primary health care professionals.

Stereotyped behaviour in children with autism and intellectual disability: an examination of the executive dysfunction hypothesis

BACKGROUND

Increasing attention has been paid to the executive dysfunction hypothesis argued to underpin stereotyped behaviour in autism. The aim of this study is to investigate one component of this model, that stereotyped behaviours are related to impaired generativity and compromised behavioural inhibition, by examining whether episodes of these behaviours terminate naturally without external intervention.

METHODS

Using a naturalistic observational methodology the stereotyped behaviours of six participants with autism were recorded in real time over periods ranging from 3.59 to 9.20 h. Data were also recorded for teaching staff interactions with participants and environmental settings (one-to-one, group and freetime).

RESULTS

In comparison with one-to-one settings stereotyped behaviours were more frequent when participants were in freetime settings with the exception of one participant. For the termination of stereotyped behaviours these behaviours stopped with no ongoing physical or verbal adult contact being evident for a median of 73.25% of the time. Additionally, for a median of 89.40% of the time stereotyped behaviour stopped without the initiation of adult contact.

DISCUSSION

The termination of bouts of stereotyped behaviour was frequently not associated with any adult contact and thus this form of external intervention. This finding warrants explanation by extending the hypothesis that compromised impaired generativity and behavioural inhibition offers a complete explanation of stereotyped behaviours.

Neuropsychologische Modelle von Autismus-Spektrum-Störungen

Fragestellung: Der Artikel gibt einen Überblick über die Modelle der Theory of Mind (ToM), Exekutivfunktionen (EF) und Zentralen Kohärenz (ZK), welche die neuropsychologischen Auffälligkeiten bei Menschen mit Autismus-Spektrum Störungen (ASS) treffend zu beschreiben vermögen. Methodik: In einem selektiven Review werden Ergebnisse behavioraler und funktionell-bildgebender Arbeiten zu den sozial-kognitiven, emotionalen und exekutiven Funktionen sowie der lokal-orientierten Wahrnehmung bei ASS berichtet. Ergebnisse: Beeinträchtigungen in ToM und EF sowie Besonderheiten in ZK sind vielfach replizierte Phänomene bei ASS. Vor allem soziale Wahrnehmungsprobleme und ToM haben einen hohen Erklärungswert für die klinische Symptomatik von ASS. Cerebrale Aktivierungsmuster unterscheiden sich bei Menschen mit und ohne ASS für ToM, EF und ZK. Als übergeordnetes neurales Erklärungsmodell scheint sich verringerte Konnektivität rekrutierter kortikaler Netzwerke gegen das Konzept einzelner betroffener Gehirnareale durchzusetzen. Schlussfolgerungen: Für ein besseres Verständnis der komplexen Zusammenhänge bei ASS ist eine zukünftige Integration klinischer, neuropsychologischer, funktionell-bildgebender und molekulargenetischer Befunde essenziell. Schwächen bei ToM und EF sowie Stärken in den Bereichen detail-orientierte Wahrnehmung sollten bei der individuellen Interventionsplanung verstärkt Eingang finden.

Cooperation and heterogeneity of the autistic mind

Individuals with autism spectrum conditions (ASCs) have a core difficulty in recursively inferring the intentions of others. The precise cognitive dysfunctions that determine the heterogeneity at the heart of this spectrum, however, remains unclear. Furthermore, it remains possible that impairment in social interaction is not a fundamental deficit but a reflection of deficits in distinct cognitive processes. To better understand heterogeneity within ASCs, we employed a game-theoretic approach to characterize unobservable computational processes implicit in social interactions. Using a social hunting game with autistic adults, we found that a selective difficulty representing the level of strategic sophistication of others, namely inferring others' mindreading strategy, specifically predicts symptom severity. In contrast, a reduced ability in iterative planning was predicted by overall intellectual level. Our findings provide the first quantitative approach that can reveal the underlying computational dysfunctions that generate the autistic "spectrum."

Expression of social behaviors of C57BL/6J versus BTBR inbred mouse strains in the visible burrow system

The core symptoms of autism spectrum disorder (ASD) include deficits in social interaction, impaired communication, and repetitive behaviors with restricted interests. Mouse models with behavioral phenotypes relevant to these core symptoms offer an experimental approach to advance the investigation of genes associated with ASD. Previous findings demonstrate that BTBR T+ tf/J (BTBR) is an inbred mouse strain that shows robust behavioral phenotypes with analogies to all three of the diagnostic symptoms of ASD. In the present study, we investigated the expression of social behaviors in a semi-natural visible burrow system (VBS), during colony formation and maintenance in groups comprising three adult male mice of the same strain, either C57BL/6J (B6) or BTBR. For comparative purposes, an extensively investigated three-chambered test was subsequently used to assess social approach in both strains. The effects of strain on these two situations were consistent and highly significant. In the VBS, BTBR mice showed reductions in all interactive behaviors: approach (front and back), flight, chase/follow, allo-grooming and huddling, along with increases in self-grooming and alone, as compared to B6. These results were corroborated in the three-chambered test: in contrast to B6, male BTBR mice failed to spend more time in the side of the test box containing the unfamiliar CD-1 mouse. Overall, the present data indicates that the strain profile for BTBR mice, including consistent social deficits and high levels of repetitive self-grooming, models multiple components of the ASD phenotype.

Unravelling neurogenetic networks implicated in developmental language disorders

Childhood syndromes disturbing language development are common and display high degrees of heritability. In most cases, the underlying genetic architecture is likely to be complex, involving multiple chromosomal loci and substantial heterogeneity, which makes it difficult to track down the crucial genomic risk factors. Investigation of rare Mendelian phenotypes offers a complementary route for unravelling key neurogenetic pathways. The value of this approach is illustrated by the discovery that heterozygous FOXP2 (where FOX is forkhead box) mutations cause an unusual monogenic disorder, characterized by problems with articulating speech along with deficits in expressive and receptive language. FOXP2 encodes a regulatory protein, belonging to the forkhead box family of transcription factors, known to play important roles in modulating gene expression in development and disease. Functional genetics using human neuronal models suggest that the different FOXP2 isoforms generated by alternative splicing have distinct properties and may act to regulate each other's activity. Such investigations have also analysed the missense and nonsense mutations found in cases of speech and language disorder, showing that they alter intracellular localization, DNA binding and transactivation capacity of the mutated proteins. Moreover, in the brains of mutant mice, aetiological mutations have been found to disrupt the synaptic plasticity of Foxp2-expressing circuitry. Finally, although mutations of FOXP2 itself are rare, the downstream networks which it regulates in the brain appear to be broadly implicated in typical forms of language impairment. Thus, through ongoing identification of regulated targets and interacting co-factors, this gene is providing the first molecular entry points into neural mechanisms that go awry in language-related disorders.

Social and communication behaviours in infants and toddlers with autism and pervasive developmental disorder-not otherwise specified

PURPOSE

Autism Spectrum Disorders (ASD) are a group of conditions characterized by symptoms that onset in early childhood. Deficits in social skills and communication are two of the core features of ASD and, if not remediated, can lead to poor long-term outcomes. Few researchers have examined characteristics of social skills and communication in infants with ASD.

METHOD

The social skills and communicative ability of 886 infants and toddlers 17-37 months of age with autism, PDD-NOS or 'at risk' for other developmental delays were evaluated using the Baby and Infant Screen for Children with aUtIsm Traits (BISCUIT). A Kruskal-Wallis test with follow-up Mann-Whitney tests were used to test for significance.

RESULTS

Infants and toddlers with autism, followed by PDD-NOS, had greater social and communication deficits than children 'at risk' for developmental delays. Items which distinguished between these diagnostic groups were determined.

CONCLUSIONS

Outcomes suggest that social and communication deficits can be identified at early ages in a population of developmentally delayed toddlers. Implications are that pinpointing emerging social and communicative autistic traits earlier will allow for more accurate assessment and diagnosis in infants with ASD. This translates into earlier intervention and more effective treatment practices.

fMRI activation during a language task in adolescents with ASD

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by language and communication impairments, social impairments, and repetitive behaviors or restricted interests. Previous studies of semantic functions have found differences in semantic processing and differences in the activation of the language network in adults with ASD compared to controls. The goal of this study is to examine semantic functions in adolescents with ASD compared to typically developing adolescents. We utilized fMRI with a reading version of a response-naming task to investigate activation in 12 right-handed adolescent boys with ASD and 12 typically developing boys. Both groups performed the task at ceiling levels. Boys with ASD had significantly stronger activation than controls in Broca's area, which was less left lateralized in ASD individuals. Controls had a significant correlation between frontal and temporal language area activation in the left hemisphere, whereas ASD adolescents did not. Direct group comparisons revealed additional regions activated in the ASD group relative to the control group. These results suggest differences in semantic organization, approaches to the semantic task, or efficiency in semantic processing in ASD adolescents relative to typically developing adolescents.

Referential communication in children with autism spectrum disorder

Referential communication was studied in children with autism spectrum disorder (ASD) including children with autism and Asperger syndrome. The aim was to study alternative explanations for the children's communicative problems in such situations. Factors studied were theory of mind, IQ, verbal ability and memory. The main results demonstrated diminished performance in children with autism spectrum disorder, mirroring performance in everyday life, in comparison to verbal IQ and mental age matched typically developing children. Among children with autism spectrum disorders, there was a positive relationship between performance in referential communication and theory of mind. Memory capacity also proved to play a role in success in the task.

Mapping autism and schizophrenia onto the ontogenesis of social behaviour: A hierarchical-developmental rather than diametrical perspective

Co-morbidity of schizophrenia and autism is low because interpersonal concerns of schizophrenic patients presuppose developmental achievements that are absent in autism. Autism may arise if primary anxiety is not overcome at a key developmental stage by affective synchronisation between infant and caregiver. Schizophrenic patients will have learned to regulate primitive anxiety by affectively attuning to narrow social networks but remain highly vulnerable to exclusion from larger groups.

Emotional Intelligence and Resiliency in Young Adults With Asperger's Disorder

Asperger's disorder (AD) is characterized by sustained and pervasive difficulties with imaginative, social, and communication skills and the presence of repetitive interests and behaviours. A number of models have been proposed to help explain the AD phenotype; however, these theories have not fully accounted for the social difficulties present in individuals with AD. The concept of emotional intelligence (EI) may offer insight into the social and emotional behaviours exhibited by young adults with AD. In addition, the concept of resilience, or the capacity for individuals to cope despite risk, may further explain why some individuals with AD experience more successful outcomes than others. This study explores EI and resilience in 20 males diagnosed with AD with average to above-average cognitive abilities. Various aspects of social functioning, EI, and resilience were assessed. Results indicate that males with AD displayed intact ability EI; however, they did not display typically developed trait EI. Furthermore, trait EI was associated with important resilient and adaptive outcomes, and these findings provide opportunities for intervention. It is important that through the identification of factors that compose resilient outcomes, this research represents the first step in identifying interventions designed to strengthen protective factors within young adults diagnosed with AD.

Auditory evoked fields predict language ability and impairment in children

Recent evidence suggests that a subgroup of children with autism show similarities to children with Specific Language Impairment (SLI) in the pattern of their linguistic impairments, but the source of this overlap is unclear. We examined the ability of auditory evoked magnetic fields to predict language and other developmental abilities in children and adolescents. Following standardized assessment of language ability, nonverbal IQ, and autism-associated behaviors, 110 trails of a tone were binaurally presented to 45 7-18 year olds who had typical development, autism (with LI), Asperger Syndrome (i.e., without LI), or SLI. Using a 151-channel MEG system, latency of left hemisphere (LH) and right hemisphere (RH) auditory M50 and M100 peaks was recorded. RH M50 latency (and to a lesser extent, RH M100 latency) predicted overall oral language ability, accounting for 36% of the variance. Nonverbal IQ and autism behavior ratings were not predicted by any of the evoked fields. Latency of the RH M50 was the best predictor of clinical LI (i.e., irrespective of autism diagnosis), and demonstrated 82% accuracy in predicting Receptive LI; a cutoff of 84.6 ms achieved 92% specificity and 70% sensitivity in classifying children with and without Receptive LI. Auditory evoked responses appear to reflect language functioning and impairment rather than non-specific brain (dys)function (e.g., IQ, behavior). RH M50 latency proved to be a relatively useful indicator of impaired language comprehension, suggesting that delayed auditory perceptual processing in the RH may be a key neural dysfunction underlying the overlap between subgroups of children with autism and SLI.

Reduced MeCP2 expression is frequent in autism frontal cortex and correlates with aberrant MECP2 promoter methylation

Mutations in MECP2, encoding methyl CpG binding protein 2 (MeCP2), cause most cases of Rett syndrome (RTT), an X-linked neurodevelopmental disorder. Both RTT and autism are "pervasive developmental disorders" and share a loss of social, cognitive and language skills and a gain in repetitive stereotyped behavior, following apparently normal perinatal development. Although MECP2 coding mutations are a rare cause of autism, MeCP2 expression defects were previously found in autism brain. To further study the role of MeCP2 in autism spectrum disorders (ASDs), we determined the frequency of MeCP2 expression defects in brain samples from autism and other ASDs. We also tested the hypotheses that MECP2 promoter mutations or aberrant promoter methylation correlate with reduced expression in cases of idiopathic autism. MeCP2 immunofluorescence in autism and other neurodevelopmental disorders was quantified by laser scanning cytometry and compared with control postmortem cerebral cortex samples on a large tissue microarray. A significant reduction in MeCP2 expression compared to age-matched controls was found in 11/14 autism (79%), 9/9 RTT (100%), 4/4 Angelman syndrome (100%), 3/4 Prader-Willi syndrome (75%), 3/5 Down syndrome (60%), and 2/2 attention deficit hyperactivity disorder (100%) frontal cortex samples. One autism female was heterozygous for a rare MECP2 promoter variant that correlated with reduced MeCP2 expression. A more frequent occurrence was significantly increased MECP2 promoter methylation in autism male frontal cortex compared to controls. Furthermore, percent promoter methylation of MECP2 significantly correlated with reduced MeCP2 protein expression. These results suggest that both genetic and epigenetic defects lead to reduced MeCP2 expression and may be important in the complex etiology of autism.

Human disorders caused by the disruption of the regulation of excitatory neurotransmission

The nicotinic acetylcholine receptors (nAChRs) are members of the large family of ligand-gated ion channels, and are constituted by the assembly of five subunits arranged pseudosymmetrically around the central axis that forms a cation-selective ion pore. They are widely distributed in both the nervous system and non-neuronal tissues, and can be activated by endogenous agonists such as acetylcholine or exogenous ligands such as nicotine. Mutations in neuronal nAChRs are found in a rare form of familial nocturnal frontal lobe epilepsy (ADNFLE), while mutations in the neuromuscular subtype of the nAChR are responsible for either congenital myasthenia syndromes (adult subtype of neuromuscular nAChR) or a form of arthrogryposis multiplex congenita type Escobar (fetal subtype of neuromuscular nAChR).

Mismatch negativity in children with autism and typical development

Children with autism are often characterized as having abnormalities in auditory processing. This study examined automatic and active processing of simple auditory stimuli in children using a component of event related potentials, the mismatch negativity (MMN). Amplitude of MMN in children with autism was significantly smaller than in children with typical development in unattended conditions. However, children with autism exhibited a typical amplitude MMN when attending to the stimuli. Receptive language and MMN were not related in children with autism. Findings support the idea of abnormal automatic auditory processing by children with autism. Auditory discrimination of infrequent changes in streams of sounds appears to be accomplished through a different mechanism than in typical children, specifically through the investment of attention.

The neuropathology, medical management and dental implications of autism

BACKGROUND

A paucity of information exists in the dental literature about autism and its dental implications.

TYPES OF STUDIES REVIEWED

The authors conducted a MEDLINE search for the period 2000 through 2006, using the term "autism," with the aim of defining the condition's clinical manifestations, dental and medical treatment and dental implications.

RESULTS

Autism is a severe developmental brain disorder that appears in infancy, persists throughout life, and is characterized by impaired social interaction, abnormalities in communication (both verbal and nonverbal) and restricted interests. Often accompanying the disorder are behavioral disturbances - such as self-mutilation, aggression, psychiatric symptoms and seizures - that necessitate the administration of multiple medications to help the affected person participate effectively in the educational and rehabilitative process.

CLINICAL IMPLICATIONS

Dentists caring for people with autism must be familiar with the manifestations of the disease and its associated features so that they can garner the maximum level of patient cooperation. They also must be familiar with the medications used to treat the associated features of the disorder because many of them cause untoward orofacial and systemic reactions and may precipitate adverse interactions with dental therapeutic agents.

Social Communication Profiles of Children with Autism Spectrum Disorders Late in the Second Year of Life

This study examined social communication profiles from behavior samples videotaped between 18 and 24 months of age in three groups of children: 50 with autism spectrum disorders (ASD), 23 with developmental delays (DD), and 50 with typical development (TD). The ASD group scored significantly lower than the DD group on 5 social communication measures and the TD group on all 14 measures, indicating distinct profiles late in the second year. Understanding was the strongest predictor of developmental level and behavior regulation and inventory of gestures were the strongest predictors of autism symptoms at 3 years of age. The predictive relations suggest five pivotal skills late in the second year that have a cascading effect on outcomes of children with ASD.

Enhanced perceptual functioning in autism: an update, and eight principles of autistic perception

We propose an "Enhanced Perceptual Functioning" model encompassing the main differences between autistic and non-autistic social and non-social perceptual processing: locally oriented visual and auditory perception, enhanced low-level discrimination, use of a more posterior network in "complex" visual tasks, enhanced perception of first order static stimuli, diminished perception of complex movement, autonomy of low-level information processing toward higher-order operations, and differential relation between perception and general intelligence. Increased perceptual expertise may be implicated in the choice of special ability in savant autistics, and in the variability of apparent presentations within PDD (autism with and without typical speech, Asperger syndrome) in non-savant autistics. The overfunctioning of brain regions typically involved in primary perceptual functions may explain the autistic perceptual endophenotype.

Neural dynamics of autistic behaviors: cognitive, emotional, and timing substrates

What brain mechanisms underlie autism, and how do they give rise to autistic behavioral symptoms? This article describes a neural model, called the Imbalanced Spectrally Timed Adaptive Resonance Theory (iSTART) model, that proposes how cognitive, emotional, timing, and motor processes that involve brain regions such as the prefrontal and temporal cortex, amygdala, hippocampus, and cerebellum may interact to create and perpetuate autistic symptoms. These model processes were originally developed to explain data concerning how the brain controls normal behaviors. The iSTART model shows how autistic behavioral symptoms may arise from prescribed breakdowns in these brain processes, notably a combination of underaroused emotional depression in the amygdala and related affective brain regions, learning of hyperspecific recognition categories in the temporal and prefrontal cortices, and breakdowns of adaptively timed attentional and motor circuits in the hippocampal system and cerebellum. The model clarifies how malfunctions in a subset of these mechanisms can, through a systemwide vicious circle of environmentally mediated feedback, cause and maintain problems with them all.