Pseudo-pheochromocytoma due to obstructive sleep apnea: a case report

SUMMARY

Obstructive sleep apnea (OSA) is a condition of intermittent nocturnal upper airway obstruction. OSA increases sympathetic drive which may result in clinical and biochemical features suggestive of pheochromocytoma. We present the case of a 65-year-old male with a 2.9-cm left adrenal incidentaloma on CT, hypertension, symptoms of headache, anxiety and diaphoresis, and persistently elevated 24-h urine norepinephrine (initially 818 nmol/day (89-470)) and normetanephrine (initially 11.2 µmol/day (0.6-2.7)). He was started on prazosin and underwent left adrenalectomy. Pathology revealed an adrenal corticoadenoma with no evidence of pheochromocytoma. Over the next 2 years, urine norepinephrine and normetanephrine remained significantly elevated with no MIBG avid disease. Years later, he was diagnosed with severe OSA and treated with continuous positive airway pressure. Urine testing done once OSA was well controlled revealed complete normalization of urine norepinephrine and normetanephrine with substantial symptom improvement. It was concluded that the patient never had a pheochromocytoma but rather an adrenal adenoma with biochemistry and symptoms suggestive of pheochromocytoma due to untreated severe OSA. Pseudo-pheochromocytoma is a rare presentation of OSA and should be considered on the differential of elevated urine catecholamines and metanephrines in the right clinical setting.

LEARNING POINTS

Obstructive sleep apnea (OSA) is a common condition among adults. OSA may rarely present as pseudo-pheochromocytoma with symptoms of pallor, palpitations, perspiration, headache, or anxiety. OSA should be considered on the differential of elevated urine catecholamines and metanephrines, especially in patients with negative metaiodobenzylguanidine (MIBG) scan results.

The Association Between Reading the Mind in the Eyes Test Performance and Intelligence Quotient in Children and Adolescents With Asperger Syndrome

Background: There has been an extensive debate about a potential association between intelligence and social cognition. In this study, we aimed to assess the association between social cognition as measured with the Reading the Mind in the Eyes test (RMET) and intelligence as measured with the fourth edition of the Wechsler Intelligence Scale for Children (WISC-IV) in children and adolescents diagnosed with Asperger Syndrome (AS). Methods: We conducted a cross-sectional study among 84 children diagnosed with AS aged 6-16 years (mean = 11.64; standard deviation = 2.75; 92.9% males). We analyzed the association between RMET performance and WISC-IV total score as well as the association between RMET performance and each of the four WISC-IV indexes (processing speed index, PSI; working memory index, WMI; perceptual reasoning index, PRI, and verbal comprehension index, VCI). Results: We found a positive correlation between RMET performance and full-scale intelligence quotient (r = 0.340; p < 0.01), VCI (r = 0.310; p < 0.01), PRI (r = 0.401; p < 0.01), and WMI (r = 0.292; p < 0.01). In the linear regression model, age was a significant predictor of RMET score (β = 0.409; p < 0.001) as was PRI (β = 0.309; p = 0.019). Conclusion: Our results suggest that intelligence quotient positively influences RMET performance, indicating that intelligence increases social cognition in individuals diagnosed with AS. However, weak-to-moderate size effects were found. This study contributes to understanding the mechanisms underlying the disturbance of social cognition in children and adolescents diagnosed with AS.

融合团体箱庭疗法对Asperger综合征儿童的疗效

OBJECTIVE

To study the clinical effect of integrated sandplay therapy in preschool children with Asperger syndrome (AS).

METHODS

A total of 44 preschool children with AS were randomly divided into an experimental group and a control group, with 22 children in each group. The children in the control group were given routine training, and those in the experimental group were given integrated sandplay therapy in addition to the routine training. The treatment response was assess by the Social Responsiveness Scale (SRS), emotional recognition tools and changes in sandplay theme characteristics after 6 months of treatment.

RESULTS

Before intervention, there were no significant differences between the two groups in the total score of SRS, the score of each factor of SRS, and correct rates of facial expression recognition of the upright position, inverted position, upper face and lower face (P>0.05). After 6 months of intervention, both groups had significant reductions in the total score of SRS and the score of each factor of SRS (P<0.01); the control group had significant increases in the correct rates of facial expression recognition of all positions except the upright position (P<0.05), while the experimental group had significant increases in the correct rates of facial expression recognition of all positions (P<0.05). Compared with the control group after intervention, the experimental group had significantly lower total score of SRS and scores of all factors of SRS except social perception (P<0.01) and significantly higher correct rates of facial expression recognition of all positions (P<0.01). The experimental group had a significant change in the number of sandplay theme characteristics after intervention (P<0.01).

CONCLUSIONS

Integrated sandplay therapy can improve social responsiveness and emotion recognition ability in preschool children with AS.

[Clinical effect of integrated sandplay therapy in children with Asperger syndrome]

OBJECTIVE

To study the clinical effect of integrated sandplay therapy in preschool children with Asperger syndrome (AS).

METHODS

A total of 44 preschool children with AS were randomly divided into an experimental group and a control group, with 22 children in each group. The children in the control group were given routine training, and those in the experimental group were given integrated sandplay therapy in addition to the routine training. The treatment response was assess by the Social Responsiveness Scale (SRS), emotional recognition tools and changes in sandplay theme characteristics after 6 months of treatment.

RESULTS

Before intervention, there were no significant differences between the two groups in the total score of SRS, the score of each factor of SRS, and correct rates of facial expression recognition of the upright position, inverted position, upper face and lower face (P>0.05). After 6 months of intervention, both groups had significant reductions in the total score of SRS and the score of each factor of SRS (P<0.01); the control group had significant increases in the correct rates of facial expression recognition of all positions except the upright position (P<0.05), while the experimental group had significant increases in the correct rates of facial expression recognition of all positions (P<0.05). Compared with the control group after intervention, the experimental group had significantly lower total score of SRS and scores of all factors of SRS except social perception (P<0.01) and significantly higher correct rates of facial expression recognition of all positions (P<0.01). The experimental group had a significant change in the number of sandplay theme characteristics after intervention (P<0.01).

CONCLUSIONS

Integrated sandplay therapy can improve social responsiveness and emotion recognition ability in preschool children with AS.

Are Psychotic Experiences Related to Poorer Reflective Reasoning?

Background: Cognitive biases play an important role in the formation and maintenance of delusions. These biases are indicators of a weak reflective mind, or reduced engaging in reflective and deliberate reasoning. In three experiments, we tested whether a bias to accept non-sense statements as profound, treat metaphorical statements as literal, and suppress intuitive responses is related to psychotic-like experiences.

Methods: We tested deliberate reasoning and psychotic-like experiences in the general population and in patients with a former psychotic episode. Deliberate reasoning was assessed with the bullshit receptivity scale, the ontological confabulation scale and the cognitive reflection test (CRT). We also measured algorithmic performance with the Berlin numeracy test and the wordsum test. Psychotic-like experiences were measured with the Community Assessment of Psychic Experience (CAPE-42) scale.

Results: Psychotic-like experiences were positively correlated with a larger receptivity toward bullshit, more ontological confabulations, and also a lower score on the CRT but not with algorithmic task performance. In the patient group higher psychotic-like experiences significantly correlated with higher bullshit receptivity.

Conclusion: Reduced deliberate reasoning may contribute to the formation of delusions, and be a general thinking bias largely independent of a person's general intelligence. Acceptance of bullshit may be facilitated the more positive symptoms a patient has, contributing to the maintenance of the delusions.

From High Intellectual Potential to Asperger Syndrome: Evidence for Differences and a Fundamental Overlap-A Systematic Review

Background: An increasing number of clinicians point to similar clinical features between some children with High Intellectual Potential (HIP or "Giftedness" = Total IQ > 2 SD), and children with Autism Spectrum Disorder (ASD) without intellectual or language delay, formerly diagnosed with Asperger Syndrome. Some of these common features are social interaction impairments, special interests, and in some cases high-verbal abilities. The aim of this article is to determine whether these similarities exist at more fundamental levels, other than clinical, and to explore the literature in order to provide empirical support for an overlap between ASD and HIP. Method: First, comparative studies between ASD and HIP children were sought. Because of a lack of data, the respective characteristics of ASD and HIP subjects were explored by a cross-sectional review of different areas of research. Emphasis was placed on psychometric and cognitive evaluations, experimental and developmental assessments, and neurobiological research, following a "bottom-up" procedure. Results: This review highlights the existence of similarities in the neurocognitive, developmental and neurobiological domains between these profiles, which require further study. In addition, the conclusions of several studies show that there are differences between HIP children with a homogeneous Intellectual Quotient profile and children with a heterogeneous Intellectual Quotient profile. Conclusion: HIP seems to cover different developmental profiles, one of which might share features with ASD. A new line of investigation providing a possible starting-point for future research is proposed. Its implications, interesting from both clinical and research perspectives, are discussed.

Emotional language processing in autism spectrum disorders: a systematic review

In his first description of Autism Spectrum Disorders (ASD), Kanner emphasized emotional impairments by characterizing children with ASD as indifferent to other people, self-absorbed, emotionally cold, distanced, and retracted. Thereafter, emotional impairments became regarded as part of the social impairments of ASD, and research mostly focused on understanding how individuals with ASD recognize visual expressions of emotions from faces and body postures. However, it still remains unclear how emotions are processed outside of the visual domain. This systematic review aims to fill this gap by focusing on impairments of emotional language processing in ASD. We systematically searched PubMed for papers published between 1990 and 2013 using standardized search terms. Studies show that people with ASD are able to correctly classify emotional language stimuli as emotionally positive or negative. However, processing of emotional language stimuli in ASD is associated with atypical patterns of attention and memory performance, as well as abnormal physiological and neural activity. Particularly, younger children with ASD have difficulties in acquiring and developing emotional concepts, and avoid using these in discourse. These emotional language impairments were not consistently associated with age, IQ, or level of development of language skills. We discuss how emotional language impairments fit with existing cognitive theories of ASD, such as central coherence, executive dysfunction, and weak Theory of Mind. We conclude that emotional impairments in ASD may be broader than just a mere consequence of social impairments, and should receive more attention in future research.

Evaluation of regression in autism spectrum disorder based on parental reports

BACKGROUND

Research indicates that some children with autism spectrum disorder (ASD) experience a developmental regression.

AIMS

The study examined the percentage of children with autism, pervasive developmental disorder (PDD), ASD, and Asperger syndrome (AS) who were considered to be delayed (D), regressed (R), or delayed and later regressed (DR) and examined any relationship with autism severity, time of onset, factors associated with onset, gastrointestinal (GI) symptoms, race, age, and gender.

MATERIALS AND METHODS

The study reviewed developmental and medical information based on parental reports of 135 children with a diagnosis of autism, PDD, ASD, or AS.

RESULTS

The number of children in the D group was 53 (39.2%) with 19 (14.1%) in the DR group and 63 (46.7%) in the R group. Thus, 82 children (60.7%) were reported to have R. In regard to onset of symptoms, there was a significant difference between the D and R groups as well as between the DR and R groups. The analyses showed that there was no significant relationship between age, gender, race, severity, or GI symptoms and membership in any group; D, DR, or R. The majority of parents reported that the regression was preceded by or was associated with vaccinations (57.3%) or another medically related event (11.0%).

CONCLUSIONS

The findings are consistent with previous research and reinforce our understanding of regression in those children with an ASD diagnosis.

Differences in global and local level information processing in autism: an fMRI investigation

People with autism spectrum disorders (ASD) have atypical visual perception of global and local information. Previous neuroimaging studies have examined the functional anatomy of locally directed attention during visual processing in ASD, but few have examined differences in both globally and locally directed attention. We performed functional magnetic resonance imaging (fMRI) in 17 adults with ASD and 16 typically developing (TD) subjects to examine the neurobiology of both global- and local-level information processing in ASD using an abstract hierarchical design task. TD subjects showed no regions of increased brain activation relative to subjects with ASD as assessed using whole brain analysis. Subjects with ASD exhibited greater activation in right superior frontal gyrus during locally directed attention. During globally directed attention, the ASD group showed greater right lateral occipital activation. Additionally, subjects with ASD showed less deactivation in medial prefrontal cortex (part of the default mode network) in the globally directed attention condition. Our findings help elucidate networks of brain activation related to atyipcal global and local feature processing in ASD.

Absence of age-related prefrontal NAA change in adults with autism spectrum disorders

Atypical trajectory of brain growth in autism spectrum disorders (ASDs) has been recognized as a potential etiology of an atypical course of behavioral development. Numerous neuroimaging studies have focused on childhood to investigate atypical age-related change of brain structure and function, because it is a period of neuron and synapse maturation. Recent studies, however, have shown that the atypical age-related structural change of autistic brain expands beyond childhood and constitutes neural underpinnings for lifelong difficulty to behavioral adaptation. Thus, we examined effects of aging on neurochemical aspects of brain maturation using 3-T proton magnetic resonance spectroscopy ((1)H-MRS) with single voxel in the medial prefrontal cortex (PFC) in 24 adult men with non-medicated high-functioning ASDs and 25 age-, IQ- and parental-socioeconomic-background-matched men with typical development (TD). Multivariate analyses of covariance demonstrated significantly high N-acetylaspartate (NAA) level in the ASD subjects compared with the TD subjects (F=4.83, P=0.033). The low NAA level showed a significant positive correlation with advanced age in the TD group (r=-0.618, P=0.001), but was not evident among the ASD individuals (r=0.258, P=0.223). Fisher's r-to-z transformation showed a significant difference in the correlations between the ASD and TD groups (Z=-3.23, P=0.001), which indicated that the age-NAA relationship was significantly specific to people with TD. The current (1)H-MRS study provided new evidence that atypical age-related change of neurochemical aspects of brain maturation in ASD individuals expands beyond childhood and persists during adulthood.

Characterization of depression in children with autism spectrum disorders

Depressive syndromes represent a disabling comorbidity for many children with autism spectrum disorders (ASD); however, the ascertainment of depression can be complicated by phenotypic overlap between the 2 conditions, by ways in which autistic symptomatology can mask cardinal features of depression and by atypical manifestations of depression in children with ASD. These issues have contributed to wide variation in the estimation of prevalence rates of depression in individuals with ASD and invoke the need for new approaches to the specific detection of depression and other neuropsychiatric comorbidities that aggregate in children affected by ASD. The authors review the scientific literature relevant to the occurrence of depression in ASD and consider important parameters of risk, including psychosocial factors such as insight into affectation status, as well as biological factors such as the aggregation of depressive syndromes in certain families affected by autism, which has suggested possible overlap in genetic influences underlying the 2 conditions. Variability in the manifestations of depression across environmental contexts provides important clues to intervention and underscores the potential importance of involving multiple informants in ascertaining depression in children and adolescents with ASD. A practical strategy for evaluating the presence of depression in youth with ASD is synthesized from the available data and discussed.

Patterns of visual attention to faces and objects in autism spectrum disorder

This study used eye-tracking to examine visual attention to faces and objects in adolescents with autism spectrum disorder (ASD) and typical peers. Point of gaze was recorded during passive viewing of images of human faces, inverted human faces, monkey faces, three-dimensional curvilinear objects, and two-dimensional geometric patterns. Individuals with ASD obtained lower scores on measures of face recognition and social-emotional functioning but exhibited similar patterns of visual attention. In individuals with ASD, face recognition performance was associated with social adaptive function. Results highlight heterogeneity in manifestation of social deficits in ASD and suggest that naturalistic assessments are important for quantifying atypicalities in visual attention.

Abstract reasoning and friendship in high functioning preadolescents with autism spectrum disorders

To investigate the relationship between cognitive and social functioning, 20 Israeli individuals with HFASD aged 8-12 and 22 age, maternal education, and receptive vocabulary-matched preadolescents with typical development (TYP) came to the lab with a close friend. Measures of abstract reasoning, friendship quality, and dyadic interaction during a play session were obtained. As hypothesized, individuals with HFASD were significantly impaired in abstract reasoning, and there were significant group differences in friend and observer reports of friendship quality. There also was consistency in reports between friends. Two factors-"relationship appearance" and "relationship quality" described positive aspects of the relationships. Disability status and age related to relationship appearance. Proband abstract reasoning was related to relationship quality.

Perception of emotion in musical performance in adolescents with autism spectrum disorders

Individuals with autism spectrum disorders (ASD) are impaired in understanding the emotional undertones of speech, many of which are communicated through prosody. Musical performance also employs a form of prosody to communicate emotion, and the goal of this study was to examine the ability of adolescents with ASD to understand musical emotion. We designed an experiment in which each musical stimulus served as its own control while we varied the emotional expressivity by manipulating timing and amplitude variation. We asked children and adolescents with ASD and matched controls as well as individuals with Williams syndrome (WS) to rate how emotional these excerpts sounded. Results show that children and adolescents with ASD are impaired relative to matched controls and individuals with WS at judging the difference in emotionality among the expressivity levels. Implications for theories of emotion in autism are discussed in light of these findings.

Abnormal auditory forward masking pattern in the brainstem response of individuals with Asperger syndrome

Abnormal auditory information processing has been reported in individuals with autism spectrum disorders (ASD). In the present study auditory processing was investigated by recording auditory brainstem responses (ABRs) elicited by forward masking in adults diagnosed with Asperger syndrome (AS). Sixteen AS subjects were included in the forward masking experiment and compared to three control groups consisting of healthy individuals (n = 16), schizophrenic patients (n = 16) and attention deficit hyperactivity disorder patients (n = 16), respectively, of matching age and gender. The results showed that the AS subjects exhibited abnormally low activity in the early part of their ABRs that distinctly separated them from the three control groups. Specifically, wave III amplitudes were significantly lower in the AS group than for all the control groups in the forward masking condition (P < 0.005), which was not the case in the baseline condition. Thus, electrophysiological measurements of ABRs to complex sound stimuli (eg, forward masking) may lead to a better understanding of the underlying neurophysiology of AS. Future studies may further point to specific ABR characteristics in AS individuals that separate them from individuals diagnosed with other neurodevelopmental diseases.

Predicting friendship quality in autism spectrum disorders and typical development

The role played by social relationship variables (attachment security; mother-child relationship qualities) and social-cognitive capacities (theory of mind) was examined in both observed friendship behaviors and in children's descriptions of friendships (age 8-12) with high functioning children with autism spectrum disorders (HFASD) (n = 44) and with typical development (TYP) (n = 38). Overall, half of the HFASD sample (54.45%) reported maternal attachment security, corroborating data from younger children with ASD. The hypothesized predictors and their interrelations had both direct and indirect effects on friendship for both groups of children, highlighting the importance of these factors in children's friendship development and suggesting both compensatory and amplification mechanisms for friendship qualities. Practical and clinical implications are discussed for friendship support in both ASD and TYP.

Explaining and inducing savant skills: privileged access to lower level, less-processed information

I argue that savant skills are latent in us all. My hypothesis is that savants have privileged access to lower level, less-processed information, before it is packaged into holistic concepts and meaningful labels. Owing to a failure in top-down inhibition, they can tap into information that exists in all of our brains, but is normally beyond conscious awareness. This suggests why savant skills might arise spontaneously in otherwise normal people, and why such skills might be artificially induced by low-frequency repetitive transcranial magnetic stimulation. It also suggests why autistic savants are atypically literal with a tendency to concentrate more on the parts than on the whole and why this offers advantages for particular classes of problem solving, such as those that necessitate breaking cognitive mindsets. A strategy of building from the parts to the whole could form the basis for the so-called autistic genius. Unlike the healthy mind, which has inbuilt expectations of the world (internal order), the autistic mind must simplify the world by adopting strict routines (external order).

Stereotypies and hyperactivity in rhesus monkeys exposed to IgG from mothers of children with autism

Autism together with Asperger syndrome and pervasive developmental disorder not otherwise specified form a spectrum of conditions (autism spectrum disorders or ASD) that is characterized by disturbances in social behavior, impaired communication and the presence of stereotyped behaviors or circumscribed interests. Recent estimates indicate a prevalence of ASD of 1 per 150 (Kuehn, 2007). The cause(s) of most cases of ASD are unknown but there is an emerging consensus that ASD have multiple etiologies. One proposed cause of ASD is exposure of the fetal brain to maternal autoantibodies during pregnancy [Dalton, P., Deacon, R., Blamire, A., Pike, M., McKinlay, I., Stein, J., Styles, P., Vincent, A., 2003. Maternal neuronal antibodies associated with autism and a language disorder. Ann. Neurol. 53, 533-537]. To provide evidence for this hypothesis, four rhesus monkeys were exposed prenatally to human IgG collected from mothers of multiple children diagnosed with ASD. Four control rhesus monkeys were exposed to human IgG collected from mothers of multiple typically developing children. Five additional monkeys were untreated controls. Monkeys were observed in a variety of behavioral paradigms involving unique social situations. Behaviors were scored by trained observers and overall activity was monitored with actimeters. Rhesus monkeys gestationally exposed to IgG class antibodies from mothers of children with ASD consistently demonstrated increased whole-body stereotypies across multiple testing paradigms. These monkeys were also hyperactive compared to controls. Treatment with IgG purified from mothers of typically developing children did not induce stereotypical or hyperactive behaviors. These findings support the potential for an autoimmune etiology in a subgroup of patients with neurodevelopmental disorders. This research raises the prospect of prenatal evaluation for neurodevelopmental risk factors and the potential for preventative therapeutics.

Friendship in high-functioning children with autism spectrum disorder: mixed and non-mixed dyads

Friendships containing a child with autism and a friend with typical development ("mixed" friendships, n = 26) and those of children with autism and a friend with a disability ("non-mixed," n = 16) were contrasted with friendships of typically developing subjects and their friends (n = 31). Measures included dyadic interaction samples, and interview and questionnaire data from subjects, friends, and parents. Mixed friendship interactions resembled typical friendships. Participants in mixed friendships were more responsive to one another, had stronger receptive language skills, exhibited greater positive social orientation and cohesion, and demonstrated more complex coordinated play than in the non-mixed dyads. Exposure to typical peers appears to have significant effects on friendship behaviors.

Do individuals with high functioning autism have the IQ profile associated with nonverbal learning disability?

Previously researchers have noted a high level of occurrence of the IQ profile associated with nonverbal learning disability (NLD) in Asperger syndrome (ASP) but not in high functioning autism (HFA). We examined the IQ profile scores of a large sample of children (n = 69) and adults (n = 77) with HFA, stringently diagnosed according to ADOS, ADI-R, and DSM-IV criteria, and a corresponding sample of typical child (n = 72) and adult controls (n = 107). At least one of the three primary components of the Wechsler pattern seen in NLD were found in 17-26% of the children and 20-32% of the adults with HFA. All three components occurred in slightly more than 5% of the children and adults with autism. Overall, the VIQ > PIQ profile seen in NLD occurred in 18% of the sample of individuals stringently diagnosed with HFA. Therefore, obtaining this IQ profile is not a valid clinical discriminator between NLD and HFA.

Pragmatic Assessment in Autism Spectrum Disorders: A Comparison of a Standard Measure With Parent Report

The purpose of this study was to investigate the concurrent validity of subtests on the Comprehensive Assessment of Spoken Language (CASL) by comparing them with the assessment of communication and social skills on the Vineland Adaptive Behavior Scales (Vineland). The participants were 35 children and adolescents with higher functioning autism spectrum disorders (ASD) who had received both the CASL and the Vineland. Results of the study suggest that the Pragmatic Judgment and Inferences subtests of the CASL appeared to document the difficulties that individuals with ASD had in adaptive use of language for communication.

Brief report: perception of genuine and posed smiles by individuals with autism

Individuals with autism are impaired in the recognition of fear, which may be due to their reduced tendency to look at the eyes. Here we investigated another potential perceptual and social consequence of reduced eye fixation. The eye region of the face is critical for identifying genuine, or sincere, smiles. We therefore investigated this ability in adults with autism. We used eye-tracking to measure gaze behaviour to faces displaying posed and genuine smiles. Adults with autism were impaired on the posed/genuine smile task and looked at the eyes significantly less than did controls. Also, within the autism group, task performance correlated with social interaction ability. We conclude that reduced eye contact in autism leads to reduced ability to discriminate genuine from posed smiles with downstream effects on social interaction.

Sleep architecture and NREM alterations in children and adolescents with Asperger syndrome

STUDY OBJECTIVES

To analyze sleep in children with Asperger syndrome (AS) by means of standard sleep questionnaires, to evaluate sleep architecture and NREM sleep alterations by means of cyclic alternating pattern (CAP) and to correlate objective sleep parameters with cognitive behavioral measures.

DESIGN

Cross-sectional study involving validated sleep questionnaires, neuropsychological scales, and PSG recording.

SETTING

Sleep medicine center.

PARTICIPANTS

Eight children with AS, 10 children with autism, and 12 healthy control children.

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

Children with AS had a higher prevalence of problems of initiating sleep and daytime sleepiness. Sleep architecture parameters showed minor differences between the 3 groups. CAP parameters showed an increased percentage of A1 and a decreased percentage of A2 subtypes in subjects with AS vs. controls. All A subtype indexes (number per hour of NREM sleep) were decreased, mostly in sleep stage 2 but not in SWS. With respect to children with autism, subjects with AS showed increased CAP rate in SWS and A1 percentage. In subjects with AS, verbal IQ had a significant positive correlation with total CAP rate and CAP rate in SWS and with global and SWS A1 index. The percentage of A2 negatively correlated with full scale IQ, verbal and performance IQ. CBCL total score correlated positively with CAP rate and A1 index while externalizing score correlated negatively with A3%.

CONCLUSIONS

This study shows peculiar CAP modifications in children with AS and represents an attempt to correlate the quantification of sleep EEG oscillations with the degree of mental ability/disability.

Impaired sadness recognition is linked to social interaction deficit in autism

Can autistic individuals use motion cues to identify simple emotions from 2D abstract animations? We compared emotion recognition ability using a novel test involving computerised animations, and a more conventional emotion recognition test using facial expressions. Adults with autism and normal controls, matched for age and verbal IQ, participated in two experiments. First, participants viewed a series of short (5s) animations. These featured an 'emotional' triangle, interacting with a circle. They were designed to evoke an attribution of emotion to the triangle, which was rated both in terms of anger, happiness, sadness or fear from its pattern of movement, and how animate ("living") it appeared to be. Second, emotion recognition was tested from standardised photographs of facial expressions. In both experiments, adults with autism were significantly impaired relative to comparisons in their perception of sadness. This is the first demonstration that, in autism, individuals can have difficulties both in the interpretation of facial expressions and in the recognition of equivalent emotions based on the movement of abstract stimuli. Poor performance in the animations task was significantly correlated with the degree of impairment in reciprocal social interaction, assessed by the Autism Diagnostic Observation Schedule. Our findings point to a deficit in emotion recognition in autism, extending beyond the recognition of facial expressions, which is associated with a functional impairment in social interaction skills. Our results are discussed in the context of the results of neuroimaging studies that have used animated stimuli and images of faces.