fMRI evidence of neural abnormalities in the subcortical face processing system in ASD.

Recent evidence suggests that a rapid, automatic face detection system is supported by subcortical structures including the amygdala, pulvinar, and superior colliculus. Early-emerging abnormalities in these structures may be related to reduced social orienting in children with autism, and subsequently, to aberrant development of cortical circuits involved in face processing. Our objective was to determine whether functional abnormalities in the subcortical face processing system are present in adults with autism spectrum disorders (ASD) during supraliminal fearful face processing. Participants included twenty-eight individuals with ASD and 25 controls group-matched on age, IQ, and behavioral performance. The ASD group met diagnostic criteria on the ADI-R, ADOS-G, and DSM-IV. Both the ASD and control groups showed significant activation in bilateral fusiform gyri. The control group exhibited additional significant responses in the right amygdala, right pulvinar, and bilateral superior colliculi. In the direct group comparison, the controls showed significantly greater activation in the left amygdala, bilateral fusiform gyrus, right pulvinar, and bilateral superior colliculi. No brain region showed significantly greater activation in the ASD group compared to the controls. Thus, basic rapid face identification mechanisms appear to be functional in ASD. However, individuals with ASD failed to engage the subcortical brain regions involved in face detection and automatic emotional face processing, suggesting a core mechanism for impaired socioemotional processing in ASD. Neural abnormalities in this system may contribute to early-emerging deficits in social orienting and attention, the putative precursors to abnormalities in social cognition and cortical face processing specialization.

The Peer Social Networks of Young Children with Down Syndrome in Classroom Programmes.

BACKGROUND: The nature and characteristics of the peer social networks of young children with Down syndrome in classroom settings were examined within a developmental framework. METHOD: Comparisons were made with younger typically developing children matched on mental age and typically developing children matched on chronological age. RESULTS: Similar patterns were found for all three groups for most peer social network measures. However, group differences were obtained for measures of teacher assistance and peer interactions in unstructured situations. CONCLUSIONS: Positive patterns appeared to be related to the social orientation of children with Down syndrome and the special efforts of teachers to support children's peer social networks. Findings also suggested that fundamental peer competence problems for children with Down syndrome remain and may best be addressed within the framework of contemporary models of peer-related social competence.

Abnormal functional connectivity in autism spectrum disorders during face processing.

Abnormalities in the interactions between functionally linked brain regions have been suggested to be associated with the clinical impairments observed in autism spectrum disorders (ASD). We investigated functional connectivity within the limbic system during face identification; a primary component of social cognition, in 19 high-functioning adults with ASD and 21 age-and IQ-matched control adults. Activation during identification of previously viewed faces and houses using a one-back paradigm was compared. The fusiform face area (FFA) was individually localized in each participant and used as the seed point for functional connectivity analyses. The degree of correlation between FFA and the extended neural circuitry involved in face identification was tested. A whole brain analysis was also conducted in order to determine whether connectivity from the FFA to aberrant brain locations was present in the ASD group. Measures of clinical severity (ADOS social score and ADI-R social score) were included as independent variables into the functional connectivity analyses. Significant FFA-amygdala and FFA-superior temporal sulcus functional connectivity was found in both the ASD and control participants. However, the control group had significantly increased connectivity to the left amygdala and the posterior cingulate compared to ASD. Post hoc analyses additionally found increased connectivity to the thalamus in the controls. A significant relationship between abnormal functional connectivity and clinical severity in the ASD group was observed. Specifically, greater social impairment was associated with reduced FFA-amygdala connectivity and increased FFA-right inferior frontal connectivity. These results suggest that abnormal neural connections within the limbic system may contribute to the social impairments observed in ASD.

An investigation of the relationship between fMRI and ERP source localized measurements of brain activity during face processing.

Brain activity patterns during face processing have been extensively explored with functional magnetic resonance imaging (fMRI) and event-related potentials (ERPs). ERP source localization adds a spatial dimension to the ERP time series recordings, which allows for a more direct comparison and integration with fMRI findings. The goals for this study were (1) to compare the spatial descriptions of neuronal activity during face processing obtained with fMRI and ERP source localization using low-resolution electromagnetic tomography (LORETA), and (2) to use the combined information from source localization and fMRI to explore how the temporal sequence of brain activity during face processing is summarized in fMRI activation maps. fMRI and high-density ERP data were acquired in separate sessions for 17 healthy adult males for a face and object processing task. LORETA statistical maps for the comparison of viewing faces and viewing houses were coregistered and compared to fMRI statistical maps for the same conditions. The spatial locations of face processing-sensitive activity measured by fMRI and LORETA were found to overlap in a number of areas including the bilateral fusiform gyri, the right superior, middle and inferior temporal gyri, and the bilateral precuneus. Both the fMRI and LORETA solutions additionally demonstrated activity in regions that did not overlap. fMRI and LORETA statistical maps of face processing-sensitive brain activity were found to converge spatially primarily at LORETA solution latencies that were within 18 ms of the N170 latency. The combination of data from these techniques suggested that electrical brain activity at the latency of the N170 is highly represented in fMRI statistical maps.

Category-specific naming and recognition deficits in temporal lobe epilepsy surgical patients.

OBJECTIVE: Based upon Damasio's "convergence zone" model of semantic memory, we predicted that epilepsy surgical patients with anterior temporal lobe (TL) seizure onset would exhibit a pattern of category-specific naming and recognition deficits not observed in patients with seizures arising elsewhere. METHODS: We assessed epilepsy patients with unilateral seizure onset of anterior TL or other origin (n=22), pre- or post-operatively, using a set of category-specific items and a conventional measure of visual naming (Boston Naming Test: BNT). RESULTS: Category-specific naming deficits were exhibited by patients with dominant anterior TL seizure onset/resection for famous faces and animals, while category-specific recognition deficits for these same categories were exhibited by patients with nondominant anterior TL onset/resection. Patients with other seizure onset did not exhibit category-specific deficits. Naming and recognition deficits were frequently not detected by the BNT, which samples only a limited range of stimuli. INTERPRETATION: Consistent with the "convergence zone" framework, results suggest that the nondominant anterior TL plays a major role in binding sensory information into conceptual percepts for certain stimuli, while dominant TL regions function to provide a link to verbal labels for these percepts. Although observed category-specific deficits were striking, they were often missed by the BNT, suggesting that they are more prevalent than recognized in both pre- and post-surgical epilepsy patients. Systematic investigation of these deficits could lead to more refined models of semantic memory, aid in the localization of seizures, and contribute to modifications in surgical technique and patient selection in epilepsy surgery to improve neurocognitive outcome.

Functional magnetic resonance imaging in nursing research.

Functional magnetic resonance imaging (fMRI) is a powerful noninvasive neuroimaging technique nurse scientists can use to investigate the structure and cognitive capacities of the brain. A strong magnetic field and intermittent high-frequency pulses cause protons in body tissues to release energy, which can be recorded and processed into images that are sensitive to specific tissue characteristics. Although temporal and spatial resolution constraints define an upper limit to the precision of magnetic resonance (MR) scanners, the primary index of neuronal activity, hemodynamic response, can be efficiently estimated. Characteristics of the experimental environment, the hypothesis of interest, and the physiology of the cognitive process under investigation provide guidance for the design and limit available options. The processing of functional data to remove unwanted variability is briefly described as are the techniques used to estimate statistical effects and control for the rate of false positives in the results. A detailed applied example of nursing research is included to demonstrate the practical application of the theory, methods, and techniques being discussed. A glossary of key terms is also provided.

Replicable functional magnetic resonance imaging evidence of correlated brain signals between physically and sensory isolated subjects.

OBJECTIVES: Previous electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) experiments have suggested that correlated neural signals may be detected in the brains of individuals who are physically and sensorily isolated from each other. Functional MRI and EEG methods were used in the present study in an attempt to replicate these findings. DESIGN/SETTINGS: Subjects were electrically and magnetically shielded because of the characteristic surroundings of the scanner room. During the experiment, the nonstimulated subject was placed in the scanner with sensory isolating goggles covering the subject's eyes. The stimulated subject was placed 30 feet away and sat in front of a video monitor that presented an alternating schedule of six stimulus-on/stimulus-off conditions. The stimulus- on condition consisted of a flickering checkerboard pattern whereas the stimulus-off condition consisted of a static checkerboard. Stimulus-on/-off conditions were presented in the sequence on/off/on/off/on/off. The duration of these intervals was randomly assigned but consistently provided a total of 150 seconds of flicker and 150 seconds of static. Sessions were repeated twice to assess possible replication of the phenomenon. OUTCOME MEASURES: Changes in fMRI brain activation (relating to blood oxygenation) and EEG signals were measured in the nonstimulated subjects. Changes occurring during stimulus-on conditions were statistically compared to changes occurring during the stimulus-off conditions. RESULTS: Statistically significant changes in fMRI brain activation and EEG signals were observed when comparing the stimulus-on condition to the stimulus-off condition in nonstimulated subjects (p < 0.001, corrected for multiple comparisons). For fMRI, these changes were observed in visual brain areas 18 and 19 (Brodmann areas). One of the subjects replicated the results. CONCLUSIONS: These data replicate previous findings suggesting that correlated neural signals may be detected by fMRI and EEG in the brains of subjects who are physically and sensorily isolated from each other.

Electroencephalographic evidence of correlated event-related signals between the brains of spatially and sensory isolated human subjects.

OBJECTIVE: To determine whether correlated event-related potentials (ERPs) can be detected between the brains of spatially and sensory isolated human subjects. DESIGN AND SETTING: Simultaneous digitized electroencephalograms (EEGs) were recorded from the occipital area in pairs of human subjects placed in sound attenuated rooms separated by 10 meters. One person relaxed in one of the rooms while the other received visual stimulation while in the other room. Prior to each experiment, members of the pair were randomly designated as sender and receiver. Sessions were subsequently repeated with subjects reversing their roles. Previous to each session, the sender was instructed "to attempt sending an image/thought." The receiver was instructed "to remain open to receive any image/thought from his/her partner." Alternating stimulus-on/stimulus-off conditions were presented throughout the session to the sender, while a stimulus-off condition was presented to the receiver. SUBJECTS: Thirty-seven (37) female, and 23 male subjects (n = 60; 30 pairs) participated in the study. Subjects knew each other well and claimed to have previous experience of being emotionally/psychologically connected to one another. OUTCOME MEASURES: A Runs test was applied to compare EEG "hits" in the receiver's EEG during the sender' stimulus-on condition versus sender's stimulus-off conditions. Test results at p < 0.01 were considered evidence of correlated brain signals. Pairs in whom at least one member had significant results were invited back for replication. RESULTS: Of the 60 subjects tested, 5 (4 women/1 man) showed significantly higher brain activation (p < 0.01) during their sending partner's stimulus-on condition as compared to stimulus-off condition. Using the Stouffer z meta-analytic method all receiver EEG results across all 60 subjects were combined by transforming the individual session p values into z scores. Data analyses showed overall significant results for EEG data recorded during the flickering condition (z =-3.28, p = 0.0005) as well as nonsignificant results for data recorded during the static condition (z = 0.35, p = 0.64). Four pairs participated in a replication experiment during which one pair replicated the effect. CONCLUSIONS: These results indicate that in some pairs of human subjects a signal may be detected in the brain of a distant member of the pair when the brain of the other member is visually stimulated. These data support the findings of similar studies performed in seven laboratories reported in the peer-reviewed literature since 1963. Research in this area should now proceed with investigation of its physical and biologic mechanism, its generalizability to varying populations and relationships, and its clinical application.

Instrument development and evaluation of domestic preparedness training for first responders.

INTRODUCTION: In the wake of domestic terrorists attacks on 11 September 2001 and subsequent bioterrorist events employing anthrax, there no longer can be any debate about the potential for attacks employing Nuclear, Biological, or Chemical (NBC)/Weapons of Mass Destruction (WMD). As one way of acknowledging this long-standing threat and, in a concerted effort to mitigate the effects of possible future domestic NBC/WMD terrorist attacks, the US Department of Defense (DOD) and other US governmental agencies already had mounted an effort to provide Domestic Preparedness Training for First Responders in urban centers throughout the USA. METHODS: A paper and pencil questionnaire specifically designed to evaluate the effectiveness of Domestic Preparedness Training for Emergency First Responders has been developed. An earlier version of this instrument was piloted with a convenience sample of firefighters and paramedics (n = 78) in a northwest state. Based on replies to the pilot questionnaire, a pool of 27 items based on the objectives and content of the NBC/WMD Domestic Preparedness Awareness and Operations courses (plus additional background and appraised competency items) were selected for inclusion in a Domestic Preparedness Questionnaire (DPQ). RESULTS: This paper first describes the essential psychometric properties of the DPQ based on replies from baseline and follow-up samples (n = 206 and n = 246 respectively) of urban firefighters and paramedics employed by a metropolitan city in a northwest state. The DPQ was employed to evaluate the outcomes of Domestic Preparedness training provided to a sample of urban fire-service personnel. The DPQ documented significant improvements in a group of "DP trained"-urban firefighters (n = 80) both in their awareness and operations content knowledge as well as in their perceived competencies to respond to acts of biological, chemical, or nuclear terrorism "in their own community" at four months post-training. A comparison group of "Not DP-trained" firefighters (n = 78) showed no statistically significant changes on these DPQ indices, suggesting that the documented improvements in the "DP-trained" firefighters on the DPQ were not due to "test reactivity" or to "historical" factors. CONCLUSION: The findings suggest that the DPQ has adequate inter-item and test-retest reliability, possesses concurrent validity, and appears to be a sensitive measure of the Domestic Preparedness Training provided for urban firefighter and paramedic First Responders.

First record: a methodological approach to counter sampling bias.

One goal of survey research is to optimize sampling procedures so that the collected data will produce accurate population estimates. In this context, sampling bias is a primary threat to a study's validity. If individuals who do not respond are a random sample of the population, then the estimates obtained from such a subsample are unbiased. However, as the percentage of nonrespondents increases, the assumption of unbiased estimation becomes increasingly tenuous. At this point an investigator has two choices: delete all subjects who have not provided data as part of the first data collection, or allow a respondent's point of entry to define his baseline measures for the study. No previous discussion of the latter option has been noted in the methods literature. Therefore the authors have termed this approach to baseline the "first record". Conditions under which the "first record" technique would be appropriate or inappropriate are discussed.

Disaster Research Team Building: A Case Study of a Web-based Disaster Research Training Program.

This case study describes the process and outcomes of the Northwest Center for Public Health Practice Child and Family Disaster Research Training (UWDRT) Program housed at the University of Washington, which used web-based distance learning technology. The purposes of this program were to provide training and to establish a regional cadre of researchers and clinicians; to increase disaster mental health research capacity and collaboration; and to improve the scientific rigor of research investigations of disaster mental health in children and families. Despite a number of obstacles encountered in development and implementation, outcomes of this program included increased team member awareness and knowledge of child and family disaster mental health issues; improved disaster and public health instruction and training independent of the UWDRT program; informed local and state disaster response preparedness and response; and contributions to the child and family disaster mental health research literature.

Peer-related social competence of young children with Down syndrome.

The peer-related social competence of children with Down syndrome was examined in an observational study. Dyadic interactions with peers of children with Down syndrome were compared with the dyadic interactions of matched groups of typically developing children and with playmates differing in both familiarity and social skills. Results suggested that both risk and protective factors influenced the peer interactions of children with Down syndrome. Recommendations are made for applying contemporary models of peer-related social competence to etiologic subgroups to better understand the mechanisms involved and to provide direction for the design of intervention programs.

Association between amygdala response to emotional faces and social anxiety in autism spectrum disorders.

Difficulty interpreting facial expressions has been reported in autism spectrum disorders (ASD) and is thought to be associated with amygdala abnormalities. To further explore the neural basis of abnormal emotional face processing in ASD, we conducted an fMRI study of emotional face matching in high-functioning adults with ASD and age, IQ, and gender matched controls. In addition, we investigated whether there was a relationship between self-reported social anxiety and fMRI activation. During fMRI scanning, study participants were instructed to match facial expressions depicting fear or anger. The control condition was a comparable shape-matching task. The control group evidenced significantly increased left prefrontal activation and decreased activation in the occipital lobes compared to the ASD group during emotional face matching. Further, within the ASD group, greater social anxiety was associated with increased activation in right amygdala and left middle temporal gyrus, and decreased activation in the fusiform face area. These results indicate that level of social anxiety mediates the neural response to emotional face perception in ASD.

Home-based peer social networks of young children with Down syndrome: a developmental perspective.

Numerous dimensions of the peer social networks of children with Down syndrome were examined within a developmental framework. Results revealed that for many key measures, particularly involvement in play, linkages to other settings, and control of play, children with Down syndrome have less well-developed peer networks even in comparison to a mental age matched group of typically developing children. This suggests both an absence of any social advantage in the peer context for children with Down syndrome and the existence of unusual difficulties that may be traced to underlying problems in peer-related social competence. The need for future observational studies of peer interactions for this group of children was emphasized.

Reduced neural habituation in the amygdala and social impairments in autism spectrum disorders.

OBJECTIVE: Amygdala dysfunction has been proposed as a critical component in social impairment in autism spectrum disorders. This study was designed to investigate whether abnormal habituation characterizes amygdala dysfunction in autism spectrum disorders and whether the rate of amygdala habituation is related to social impairment. METHOD: Using functional MRI, the authors measured change over time in activation of the amygdala and fusiform gyrus to neutral facial stimuli in adults with autism spectrum disorders and healthy comparison adults. RESULTS: The comparison group evidenced significantly greater amygdala habituation bilaterally than the autism spectrum group. There were no group differences in overall fusiform habituation. For the autism spectrum group, lower levels of habituation of the amygdala to the face stimuli were associated with more severe social impairment. CONCLUSIONS: These results suggest amygdala hyperarousal in autism spectrum disorders in response to socially relevant stimuli. Further, sustained amygdala arousal may contribute to the social deficits observed in autism spectrum disorders.

Neurological correlates of reward responding in adolescents with and without externalizing behavior disorders.

Opposing theories of striatal hyper- and hypodopaminergic functioning have been suggested in the pathophysiology of externalizing behavior disorders. To test these competing theories, the authors used functional MRI to evaluate neural activity during a simple reward task in 12- to 16-year-old boys with attention-deficit/hyperactivity disorder and/or conduct disorder (n = 19) and in controls with no psychiatric condition (n = 11). The task proceeded in blocks during which participants received either (a) monetary incentives for correct responses or (b) no rewards for correct responses. Controls exhibited striatal activation only during reward, shifting to anterior cingulate activation during nonreward. In contrast, externalizing adolescents exhibited striatal activation during both reward and nonreward. Externalizing psychopathology appears to be characterized by deficits in processing the omission of predicted reward, which may render behaviors that are acquired through environmental contingencies difficult to extinguish when those contingencies change.

Altered medial temporal lobe responses during visuospatial encoding in healthy APOE*4 carriers.

The apolipoprotein varepsilon4 allele (APOE*4) is a major genetic risk factor for Alzheimer's disease (AD) and has been associated with altered cortical activation as assessed by functional neuroimaging in cognitively normal younger and older carriers. We chose to evaluate medial temporal lobe (MTL) activation during encoding and recognition using a perspective-dependent (route or survey) visuospatial memory task by monitoring the blood-oxygen-level-dependent (BOLD) fMRI response in older, non-demented APOE*4 carriers (APOE*4+) and non-carriers (APOE*4-). During encoding, the APOE*4- group had greater average task-associated BOLD responses in ventral visual pathways, including the MTLs, as compared to the APOE*4+ group. Furthermore, MTL activation was greater during route encoding than survey encoding on average in APOE*4-, but not APOE*4+, subjects. During recognition, both groups performed similarly and no BOLD signal differences were found. Finally, within-group analysis revealed MTL activation during encoding was correlated with recognition performance in APOE*4-, but not APOE*4+ subjects. Reduced task-associated MTL activation that does not correlate with either visuospatial perspective or task performance suggests that MTL dysregulation occurs prior to clinical symptoms of dementia in APOE*4 carriers.

Methodological issues associated with group intervention research.

Interventions using a group format can be powerful treatment modalities. However, a review of nursing journals most likely to report the conduct of group research by nurses showed that less than 1% of nursing research reports used this approach and that none accounted for group-level effects in the analysis. This article discusses methodological issues inherent in group intervention research. We begin by offering examples of variables that can be incorporated into group research. We then present some challenges that researchers must address in collecting data when group formats are used. We end with recommendations for conducting group intervention research and by addressing issues associated with interpreting and reporting results.

A process for consolidation of redundant documentation forms.

Forms capturing redundant data can lead to duplicate documentation. This can be a source of patient and staff frustration, as well as data errors. The definition of a process aimed at examining the data captured on forms documenting similar aspects of patient care is necessary to avoid this problem of duplicate documentation. A data-driven systematic process for consolidation of the multiple redundant forms used in various patient care areas across a healthcare delivery system is proposed and tested using the 21 intake forms currently used by a regional Health Maintenance Organization (HMO). The analytic and subsequent reporting processes used in this project provide a systematic method of forms consolidation that can be applied to other settings.