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News

Autism’s brain signature lingers even after loss of diagnosis

by  /  1 April 2016
Gone, not forgotten: Language tasks elicit different degrees of activation in certain brain regions (colored areas) in children who once had autism than in children who never did.

Roughly 7 percent of children with autism eventually lose their diagnosis, swapping social problems and language difficulties for more typical skills and behaviors. But it is unclear whether this transition is associated with a return to typical brain function or reflects a compensatory process.

New findings support the second possibility. They suggest that children who achieve a so-called ‘optimal outcome’ have unusually active language regions in the brain relative to children with mild autism or those without the condition1.

“The complete normalization of language skills that we observe in children with optimal outcomes from autism seems to reflect a rather atypical organization at the level of the brain,” says study researcher Inge-Marie Eigsti, associate professor of psychology at the University of Connecticut.

Children who achieve an optimal outcome may receive earlier and more intense autism treatments than children who keep their autism diagnosis, according to a 2014 report by Eigsti’s group in the Journal of Developmental and Behavioral Pediatrics2. The new study, which appeared in December in NeuroImage: Clinical, suggests these early interventions spark compensatory brain changes rather than promoting neurotypical brain development.

“This finding gives us insight into how brains respond to intervention in autism, and has the potential to inform intervention strategies and monitoring of response to intervention in autism in the future,” says Lisa Shulman, director of the RELATE program for children with autism at Albert Einstein College of Medicine in New York, who was not involved in the research.

Paper trail:

Eigsti and her team studied 59 children and young adults, 8 to 21 years old, including 20 typically developing participants and 39 who were diagnosed with mild autism before age 5. Of the individuals with mild autism, 16 later lost their diagnosis.

To confirm these diagnoses, the researchers reviewed each child’s medical records and used a clinical checklist for autism called the Autism Diagnostic Observation Schedule (ADOS). They also used the Autism Diagnostic Interview-Revised (ADI-R), which relies on parent or caregiver reports to document a child’s history of autism behaviors, and the Wechsler Abbreviated Scale of Intelligence, which measures cognitive ability.

The researchers then monitored brain activity with functional magnetic resonance imaging as participants responded to short true-or-false questions that tested their ability to comprehend written language.

Eigsti says she expected the children who had shed their autism diagnosis to show brain activity that mirrors the brain activity seen in the control group and not the autism group. Instead, those children showed a unique signature of brain activity that reflects a tendency to compensate for difficulty with language.

Activity burst:

In all of the participants, the tasks activated left brain language regions such as Broca’s area, which controls speech, as well as regions governing cognitive control, motor skills and motivation. Children with a history of autism also recruited regions in the right hemisphere to help with the language tasks. But those who cast off the diagnosis showed the highest levels of activation in all of the relevant language, cognitive and motor regions.

The results held up even when the researchers controlled for age, gender and intelligence level.

This new information could help researchers understand how early interventions affect the developing brain. “One common characteristic of our kids with optimal outcomes is that they’ve begun receiving behavioral interventions really quite early, even as early as 18 to 24 months,” Eigsti says. “We think that’s a really important piece of the story.”

Eigsti and her team plan to explore how this unique brain activity signature emerges over time in children with autism as they catch up with their typically developing peers.


References:
  1. Eigsti I.M. et al. Neuroimage Clin. 10 182-191 (2015) PubMed
  2. Orinstein A.J. et al. J. Dev. Behav. Pediatr. 35, 247-256 (2014) PubMed
  • Ethyl

    The old ABA used to be much more effective. We were told 50% of kids became indistinguishable from their peers. Now, we are down to 7%. Actually, I’m glad to see that. It seems much more realistic, from what I’ve seen.

    But here is something. I used Catherine Maurice’s book, “Behavioral Intervention for Young Children with Autism” when my son was age 3. I never bothered with “table ready” or “look me in the eye”. It contained (I can’t recall) a hundred (?) pages of what amounted to a language curriculum that was increasingly complex. I recall checking off each word when my son seemed to have a basic understanding of it after I presented it to him visually (via PEC’s pictures) or kinesthetically (acting out) or any other way I could come up with, but auditory. It wasn’t an easy endeavor, it took an hour a day for over a year. Eventually, we went on to other things. Yet, my son was still echolalic up to grade 4, when he began to be able to more easily access words, rather than plugging in scripts he had learned from t.v. or in others conversation. I think it was more of an output problem, though, as
    he somehow survived regular education from kindergarten to grade 3. I think he understood far more than he could convey, exactly as all children do in the beginning.

    My point in this story is, there are parts of ABA that are very language oriented. If a child with a language problem is given intensive language therapy, something good is bound to happen. In my son’s case, his verbal, as measured by an IQ test, went from 50 at age four, to 126 at age 18. Amazingly, his Visual-Spatial was that of a 10 year old at age 4, while his verbal, that of a 2 year old… All eyes, no ears…that’s an overstatement, but he was an extraordinarily visual learner. When I tried to direct his behavior, I always told myself, “SHOW him, don’t TELL him.” Now I see teachers are moving more towards modelling behavior is Special Needs classrooms. Most of the kids there have one type or another of language disability. It makes me hopeful.

    Perhaps it is this visual presentation that rewires the brain in different areas. For whatever reason, the right brain attempts to fill in what, in a typical child, would be picked up in the left hemisphere. I think that is fascinating.

    • Ethyl

      Here I am talking to my self, but I have to say, I don’t ~know~ that anything I did brought my son to his reserved but keen self today. Like a child who cannot be taught to read until he is ready, he may have developed full use of language when he was ready. It did, however, give me something to obsess on other than the fear engendered by the label.

  • Erica Eaton

    Might this brain signature have any relationship with conditions (e.g. ADHD, anxiety) that are often comorbid and that can be present after the loss of an autism diagnosis? Does it have any resemblance to the brain development of very late talkers?

  • Planet Autism

    Masking and passing is not losing the condition, even if you are able to not meet the diagnostic criteria.

  • Planet Autism

    If someone ‘lost’ their autism diagnosis then they didn’t have autism in the first place, they had something else that looked like autism.

    There was a 2013 article by Emily Willingham http://www.forbes.com/sites/emilywillingham/2013/01/17/can-people-really-grow-out-of-autism in which research found that in fact they hadn’t when they were followed up (these were the ones that really were autistic).

    Losing the diagnosis does not mean losing the condition. Masking and passing is just that and nothing more. Take a high-functioning masking autistic into an inconducive situation and watch them unravel fast.

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