Mismatch Negativity and P3a in Adolescents and Young Adults with Autism Spectrum Disorders: Behavioral Correlates and Clinical Implications.

In a sample of 37 adolescents and young adults with autism spectrum disorder (ASD) and 35 typically-developing controls (TDC), we investigated sensory symptoms by clinical measures, and Mismatch Negativity and P3a component at Fz with the frequency and duration oddball paradigms of event-related potentials. Results showed that compared to TDC, ASD participants reported more sensory symptoms, and presented a shorter P3a peak latency in the duration paradigm, which was correlated with more social awareness deficits. In the frequency paradigm, P3a parameters were correlated with sensation avoiding and attention characteristics of ASD. Our findings suggest that sensory abnormality in ASD may extend into adolescence and young adulthood. P3a latency might be a potential neurophysiological marker for ASD.

Distortion-product otoacoustic emissions and contralateral suppression findings in children with Asperger's Syndrome.

OBJECTIVES: Children with Asperger's Syndrome (AS) often demonstrate auditory behaviors such as hypersensitivity to sounds and poor performance in noisy environments. These auditory behaviors may be related to cochlear dysfunction and abnormal medial olivocochlear bundle (MOCB) activity. The objective of this study was to examine the distortion-product otoacoustic emissions (DPOAEs) with and without contralateral white noise to evaluate outer hair cell activity and MOCB activity in children with AS. METHODS: A case control study where 18 boys with AS and 18 age-matched control subjects participated in the study. For both groups, DPOAEs were recorded at 4031, 2627, 1969, and 1359 Hz f2 frequencies with and without contralateral white noise at 30 dB SL. DPOAE SNRs and difference scores were analyzed for possible differences between both groups and age subgroups (young and old children). RESULTS: In the quiet condition, there were no significant group or ear differences in DPOAEs SNR. However, DPOAEs SNR were larger at 4031 Hz than at lower frequencies in both groups, mostly due to negative effect of background noise on low frequency response. Contralateral noise resulted in both suppression and enhancement of the DPOAE SNRs in 93% of the control group and 90% of the AS group. However, there were no significant differences in suppression and enhancement between the two groups or age subgroups. The young controls had right ear advantage and significantly larger suppression at all frequencies except 4031 Hz than old controls. The young children with AS had slight left ear advantage and significantly larger suppression only at 2672 Hz compared to the old children with AS. CONCLUSIONS: The results, indicating minor differences in DPOAEs and contralateral suppression and enhancement of DPOAEs between both control and AS groups and age subgroups, suggest subtle differences in the function of the outer hair cells and the MOCB activity. Therefore, other central auditory processing in the temporal lobe, limbic system and autonomic nervous system may be involved in the generation of hypersensitivity to sounds and difficulty understanding in noisy environments in children with AS.

Sensory abnormalities in autism. A brief report.

Sensory abnormalities were assessed in a population-based group of 208 20-54-month-old children, diagnosed with autism spectrum disorder (ASD) and referred to a specialized habilitation centre for early intervention. The children were subgrouped based upon degree of autistic symptoms and cognitive level by a research team at the centre. Parents were interviewed systematically about any abnormal sensory reactions in the child. In the whole group, pain and hearing were the most commonly affected modalities. Children in the most typical autism subgroup (nuclear autism with no learning disability) had the highest number of affected modalities. The children who were classified in an "autistic features" subgroup had the lowest number of affected modalities. There were no group differences in number of affected sensory modalities between groups of different cognitive levels or level of expressive speech. The findings provide support for the notion that sensory abnormality is very common in young children with autism. This symptom has been proposed for inclusion among the diagnostic criteria for ASD in the upcoming DSM-V.

HRV and EEG based indicators of stress in children with Asperger syndrome in audio-visual stimulus test.

Asperger syndrome (AS) is a neurobiological condition which is characterized by poor skills in social communication, and restricted and repetitive patterns of behavior and interests. We studied whether stress-related indices of heart rate variability (HRV) and electroencephalography (EEG) are different in children with AS than normal controls. We analyzed retrospectively the data of the test where audiovisual stimuli were used. We hypothesized that this test is a stressful situation for individuals with AS and they would have a greater reaction than control subjects. EEG and one-channel electrocardiography (ECG) were collected for children with diagnosis of AS (N = 20) and their age-matched controls (N = 21). HRV indices, frontal EEG asymmetry index and brain load index were calculated. HRV based indices revealed increased sympathetic activity during the test in children with AS. EEG based indices increased more in children with AS during the test compared to baseline. Thus, the children with AS seems to have a greater reaction to stressful situation.

Union and separation in the therapy of pervasive developmental disorders and ADHD.

This paper discusses the characteristics of psychotherapy for pervasive developmental disorders (PDD) in the context of the curative effects of the movement of images. The 'autistic spectrum' is widened here and includes not only PDD, but also ADHD. The main common characteristic in these two sets of disorders seems to be the lack of a subject, which manifests itself as the absence of awareness of otherness and difficulties with boundaries and language. In these cases a normal psychotherapy is ineffective as it presupposes an established subject. However a psychotherapeutic approach with these patients can contribute to the emergence of a subject. In severe cases the process of union and separation which is enacted either in the therapeutic relationship or in symbolic play leads to the birth of a subject, and of language. In milder cases, such as ADHD, the moments of separation and confrontation with the therapist suffice. I will discuss a case of my own with Asperger's syndrome in which union and separation in the play therapy occurred simultaneously. This indicates that union and separation are not a consecutive process, but are simultaneous and lead to dialectical movement. However, in neurotic cases with an established subjectivity the symbolic meaning of image plays a central role. This corresponds to Jung's understanding of image in alchemy.

Potencial de disparidad: [revisión] / Mismatch negativity: [revision]

El potencial de disparidad o mismatch negativity (MMN) corresponde a la respuesta eléctrica extraída del electroencefalograma que se produce frente a diversos cambios de las características del estímulo acústico. Se obtiene presentando al sujeto una secuencia de estímulos repetitivos de características acústicas similares (estímulo estándar) alternado en forma aleatoria con estímulos acústicos discrepantes que difieren del primero en alguno de sus atributos (estímulo discrepante). El MMN se originaría en la corteza auditiva primaria y se ha logrado registrar desde el nacimiento. No requiere la atención del sujeto, permitiendo evaluar en forma objetiva la discriminación de tonos y fonemas. En clínica se ha utilizado en evaluación del procesamiento auditivo central, pacientes con dislexia o trastorno específico del lenguaje, autismo, individuos con implante coclear e incluso en pacientes en coma. En el presente artículo se revisan las principales características, origen anatómico y utilidad clínica del MMN.

The mismatch negativity (MMN) is a specific component of the auditory event-related brain potentials. It is elicited by an infrequent, physically deviant sound (deviant-stimulus) occurring in a sequence of homogeneous repetitive sounds (standard-stimulus). MMN is probably generated in the primary auditory cortex and it has been successfully recorded in newborns. The MMN can be elicited even in the absence of attention and it can be used as an objective method to assess tone and phoneme discrimination. Some clinical applications of MMN are: evaluation of central auditory processing, patients with dyslexia or language specific disorders, autism, cochlear implant - users and even in prognosis of coma. In this article the main characteristics, origin and clinical applications of the MMN are reviewed.

Gender in voice perception in autism.

Deficits in the perception of social stimuli may contribute to the characteristic impairments in social interaction in high functioning autism (HFA). Although the cortical processing of voice is abnormal in HFA, it is unclear whether this gives rise to impairments in the perception of voice gender. About 20 children with HFA and 20 matched controls were presented with voice fragments that were parametrically morphed in gender. No differences were found in the perception of gender between the two groups of participants, but response times differed significantly. The results suggest that the perception of voice gender is not impaired in HFA, which is consistent with behavioral findings of an unimpaired voice-based identification of age and identity by individuals with autism. The differences in response times suggest that individuals with HFA use different perceptual approaches from those used by typically developing individuals.

[The use of verbal communicative abilities to increase the mean length of utterance in high-functioning autism and Asperger Syndrome]. / O uso de habilidades comunicativas verbais para aumento da extensão de enunciados no autismo de alto funcionamento e na S índrome de Asperger.

BACKGROUND: high-functioning autism (HFA) and Asperger Syndrome (AS) are pervasive developmental disorders that present alterations in the communicative and social skills. AIM: to use verbal communicative skill strategies (VCS) to increase the mean length of utterance (MLU) produced by individuals with HFA and AS. METHOD: participants were three 12-year-old males with HFA or AS. Data was collected from videotape recordings of structured verbal interaction sessions with the researcher and each participant during eight months. In order to verify the effects of the intervention, a multiple baseline research design across the participants was used, being composed by two phases: baseline (BL) and intervention (I). In the BL phase, spontaneous interaction situations occurred between the researcher and each participant. In the first phase of I, the intervention sessions occurred twice a week and gradually worked their way to once a week, but only after each participant had reached the goal of increasing the MLU. The number of sessions decreased gradually to avoid any drop in performance. The strategies which were used were divided in blocks of activities: spontaneous conversation; activities involving specific language difficulties; games with rules; story/report telling; and meta-linguistic activities. RESULTS: the application of the proposed strategies for verbal communicative abilities achieved the purpose of increasing the MLU of all three participants. CONCLUSION: suggestions are made for further researches that investigate the maintenance of the results in other environments and during the interaction with different communication partners.

Research note: exceptional absolute pitch perception for spoken words in an able adult with autism.

Autism is a neurodevelopmental disorder, characterised by deficits in socialisation and communication, with repetitive and stereotyped behaviours [American Psychiatric Association (1994). Diagnostic and statistical manual for mental disorders (4th ed.). Washington, DC: APA]. Whilst intellectual and language impairment is observed in a significant proportion of diagnosed individuals [Gillberg, C., & Coleman, M. (2000). The biology of the autistic syndromes (3rd ed.). London: Mac Keith Press; Klinger, L., Dawson, G., & Renner, P. (2002). Autistic disorder. In E. Masn, & R. Barkley (Eds.), Child pyschopathology (2nd ed., pp. 409-454). New York: Guildford Press], the disorder is also strongly associated with the presence of highly developed, idiosyncratic, or savant skills [Heaton, P., & Wallace, G. (2004) Annotation: The savant syndrome. Journal of Child Psychology and Psychiatry, 45 (5), 899-911]. We tested identification of fundamental pitch frequencies in complex tones, sine tones and words in AC, an intellectually able man with autism and absolute pitch (AP) and a group of healthy controls with self-reported AP. The analysis showed that AC's naming of speech pitch was highly superior in comparison to controls. The results suggest that explicit access to perceptual information in speech is retained to a significantly higher degree in autism.

O uso de habilidades comunicativas verbais para aumento da extensão de enunciados no autismo de alto funcionamento e na S índrome de Asperger / The use of verbal communicative abilities to increase the mean length of utterance in high-functioning autism and Asperger Syndrome

TEMA: o autismo de alto funcionamento (AAF) e a síndrome de Asperger (SA) são transtornos globais do desenvolvimento que apresentam alterações nas habilidades comunicativas e sociais. OBJETIVO: o objetivo desta pesquisa foi promover o aumento da extensão média dos enunciados (EME) produzidos por indivíduos com AAF e SA por meio de estratégias que utilizavam habilidades comunicativas verbais (HCV). MÉTODO: participaram deste estudo três indivíduos com AAF ou SA do gênero masculino, com doze anos. Os dados foram coletados mediante gravações em vídeo de sessões estruturadas de interação verbal entre cada participante e a pesquisadora durante oito meses. Foi utilizado um delineamento experimental de linha de base múltipla cruzando com sujeitos, composto por duas fases: linha de base (LB) e intervenção (I). Na LB, ocorreram situações espontâneas de interação adulto e cada participante. Na primeira fase da I, inicialmente foram realizadas sessões duas vezes por semana e só se passava para a realização de sessões semanais após o indivíduo alcançar o objetivo de aumentar a EME. Houve a diminuição gradual do número de sessões, para que não houvesse queda no desempenho. As estratégias aplicadas foram divididas em blocos atividades com conversa espontânea; atividades que envolvessem dificuldades específicas de linguagem; jogos de regras; solicitações de relatos de histórias ou acontecimentos e atividades metalingüísticas. RESULTADOS: os resultados demostraram que a utilização de HCV foi efetiva para promover o aumento da EME. CONCLUSÃO: ficam sugestões para outras pesquisas que investiguem a manutenção dos resultados obtidos em outros ambientes e em interação com vários interlocutores.

BACKGROUND: high-functioning autism (HFA) and Asperger Syndrome (AS) are pervasive developmental disorders that present alterations in the communicative and social skills. AIM: to use verbal communicative skill strategies (VCS) to increase the mean length of utterance (MLU) produced by individuals with HFA and AS. METHOD: participants were three 12-year-old males with HFA or AS. Data was collected from videotape recordings of structured verbal interaction sessions with the researcher and each participant during eight months. In order to verify the effects of the intervention, a multiple baseline research design across the participants was used, being composed by two phases: baseline (BL) and intervention (I). In the BL phase, spontaneous interaction situations occurred between the researcher and each participant. In the first phase of I, the intervention sessions occurred twice a week and gradually worked their way to once a week, but only after each participant had reached the goal of increasing the MLU. The number of sessions decreased gradually to avoid any drop in performance. The strategies which were used were divided in blocks of activities: spontaneous conversation; activities involving specific language difficulties; games with rules; story/report telling; and meta-linguistic activities. RESULTS: the application of the proposed strategies for verbal communicative abilities achieved the purpose of increasing the MLU of all three participants. CONCLUSION: suggestions are made for further researches that investigate the maintenance of the results in other environments and during the interaction with different communication partners.

Brief report: abnormal association between the thalamus and brain size in Asperger's disorder.

The objective of this study was to examine the relationship between thalamic volume and brain size in individuals with Asperger's disorder (ASP). Volumetric measurements of the thalamus were performed on MRI scans obtained from 12 individuals with ASP (age range: 10-35 years) and 12 healthy controls (age range: 9-33 years). A positive correlation was found between total brain volume and thalamic size in controls, but not in ASP subjects. This occurred in the absence of differences in mean thalamic volumes between the study groups. Findings from this investigation point to an abnormal relationship between the thalamus and its projection areas in ASP and are consistent with similar studies in autism, supporting that these disorders are qualitatively similar and possibly quantitatively different.

[Asperger syndrome - a too late diagnosed disorder?]. / Asperger-Syndrom - eine zu spät diagnostizierte Störung?

Asperger syndrome is a disorder within the autistic spectrum, which was first described by Hans Asperger in 1944. It belongs to the group of pervasive developmental disorders and is particularly characterized by qualitative impairments of social interaction and communication as well as distinct special interests and stereotyped patterns of behaviour. We present a patient, showing the typical behavioural symptoms of the Asperger syndrome, which were first diagnosed at the age of sixteen.

Atypical pattern of discriminating sound features in adults with Asperger syndrome as reflected by the mismatch negativity.

Asperger syndrome, which belongs to the autistic spectrum of disorders, is characterized by deficits of social interaction and abnormal perception, like hypo- or hypersensitivity in reacting to sounds and discriminating certain sound features. We determined auditory feature discrimination in adults with Asperger syndrome with the mismatch negativity (MMN), a neural response which is an index of cortical change detection. We recorded MMN for five different sound features (duration, frequency, intensity, location, and gap). Our results suggest hypersensitive auditory change detection in Asperger syndrome, as reflected in the enhanced MMN for deviant sounds with a gap or shorter duration, and speeded MMN elicitation for frequency changes.

Social skills training for adolescents with Asperger syndrome and high-functioning autism.

The effectiveness of a social skills training group for adolescents with Asperger syndrome and high-functioning autism (AS/HFA) was evaluated. Parents of six groups of adolescents (n = 46, 61% male, mean age 14.6) completed questionnaires immediately before and after the 12-week group. Parents and adolescents were surveyed regarding their experience with the group. Significant pre- to post-treatment gains were found on measures of both social competence and problem behaviors associated with AS/HFA. Effect sizes ranged from .34 to .72. Adolescents reported more perceived skill improvements than did parents. Parent-reported improvement suggests that social skills learned in group sessions generalize to settings outside the treatment group. Larger, controlled studies of social skills training groups would be valuable.

Processing of affective speech prosody is impaired in Asperger syndrome.

Many people with the diagnosis of Asperger syndrome (AS) show poorly developed skills in understanding emotional messages. The present study addressed discrimination of speech prosody in children with AS at neurophysiological level. Detection of affective prosody was investigated in one-word utterances as indexed by the N1 and the mismatch negativity (MMN) of auditory event-related potentials (ERPs). Data from fourteen boys with AS were compared with those for thirteen typically developed boys. These results suggest atypical neural responses to affective prosody in children with AS and their fathers, especially over the RH, and that this impairment can already be seen at low-level information processes. Our results provide evidence for familial patterns of abnormal auditory brain reactions to prosodic features of speech.

Is asperger syndrome/high-functioning autism necessarily a disability?

This article considers whether Asperger syndrome (AS) or high-functioning autism (HFA) necessarily leads to disability or whether AS/HFA simply leads to "difference." It concludes that the term "difference" in relation to AS/ HFA is a more neutral, value-free, and fairer description than terms such as "impairment," "deficiency," or "disability"; that the term "disability" only applies to the lower functioning cases of autism; but that the term "disability" may need to be retained for ASIHFA as long as the legal framework provides financial and other support only for individuals with a disability. Two models are summarized which attempt to define in what way individuals with AS/HFA are "different": the central coherence model, and the folk psychology-folk physics model. The challenge for research is to test the value of such models and to precisely characterize the differences in cognitive style.