Evaluation of Quantified Social Perception Circuit Activity as a Neurobiological Marker of Autism Spectrum Disorder.

IMPORTANCE: Autism spectrum disorder (ASD) is marked by social disability and is associated with dysfunction in brain circuits supporting social cue perception. The degree to which neural functioning reflects individual-level behavioral phenotype is unclear, slowing the search for functional neuroimaging biomarkers of ASD. OBJECTIVE: To examine whether quantified neural function in social perception circuits may serve as an individual-level marker of ASD in children and adolescents. DESIGN, SETTING, AND PARTICIPANTS: The cohort study was conducted at the Yale Child Study Center and involved children and adolescents diagnosed as having ASD and typically developing participants. Participants included a discovery cohort and a larger replication cohort. Individual-level social perception circuit functioning was assessed as functional magnetic resonance imaging brain responses to point-light displays of coherent vs scrambled human motion. MAIN OUTCOMES AND MEASURES: Outcome measures included performance of quantified brain responses in affected male and female participants in terms of area under the receiver operating characteristic curve (AUC), sensitivity and specificity, and correlations between brain responses and social behavior. RESULTS: Of the 39 participants in the discovery cohort aged 4 to 17 years, 22 had ASD and 30 were boys. Of the 75 participants in the replication cohort aged 7 to 20 years, 37 had ASD and 52 were boys. A relative reduction in social perception circuit responses was identified in discovery cohort boys with ASD at an AUC of 0.75 (95% CI, 0.52-0.89; P = .01); however, typically developing girls and girls with ASD could not be distinguished (P = .54). The results were confirmed in the replication cohort, where brain responses were identified in boys with ASD at an AUC of 0.79 (95% CI, 0.64-0.91; P < .001) and failed to distinguish affected and unaffected girls (P = .82). Across both cohorts, boys were identified at an AUC of 0.77 (95% CI, 0.64-0.86) with corresponding sensitivity and specificity of 76% each. Additionally, brain responses were associated with social behavior in boys but not in girls. CONCLUSIONS AND RELEVANCE: Quantified social perception circuit activity is a promising individual-level candidate neural marker of the male ASD behavioral phenotype. Our findings highlight the need to better understand effects of sex on social perception processing in relation to ASD phenotype manifestations.

White Matter Abnormalities in Autism and Unaffected Siblings.

This study was conducted to identify a potential neuroendophenotype for autism using diffusion tensor imaging. Whole-brain, voxel-based analysis of fractional anisotropy was conducted in 50 children: 19 with autism, 20 unaffected siblings, and 11 controls. Relative to controls, participants with autism exhibited bilateral reductions in fractional anisotropy across association, commissure, and projection fibers. The most severely affected tracts included the uncinate fasciculus, forceps minor, and inferior fronto-occipital fasciculus. Unaffected siblings also exhibited reductions in fractional anisotropy, albeit less severe with fewer affected tracts, sparing the uncinate fasciculus and forceps minor. These results suggest the presence of a neuroendophenotype for autism.

Brain Mechanisms for Processing Affective (and Nonaffective) Touch Are Atypical in Autism.

C-tactile (CT) afferents encode caress-like touch that supports social-emotional development, and stimulation of the CT system engages the insula and cortical circuitry involved in social-emotional processing. Very few neuroimaging studies have investigated the neural mechanisms of touch processing in people with autism spectrum disorder (ASD), who often exhibit atypical responses to touch. Using functional magnetic resonance imaging, we evaluated the hypothesis that children and adolescents with ASD would exhibit atypical brain responses to CT-targeted touch. Children and adolescents with ASD, relative to typically developing (TD) participants, exhibited reduced activity in response to CT-targeted (arm) versus non-CT-targeted (palm) touch in a network of brain regions known to be involved in social-emotional information processing including bilateral insula and insular operculum, the right posterior superior temporal sulcus, bilateral temporoparietal junction extending into the inferior parietal lobule, right fusiform gyrus, right amygdala, and bilateral ventrolateral prefrontal cortex including the inferior frontal and precentral gyri, suggesting atypical social brain hypoactivation. Individuals with ASD (vs. TD) showed an enhanced response to non-CT-targeted versus CT-targeted touch in the primary somatosensory cortex, suggesting atypical sensory cortical hyper-reactivity.

Dissociating the Neural Correlates of Experiencing and Imagining Affective Touch.

This functional magnetic resonance imaging (fMRI) study examined experiencing and imagining gentle arm and palm touch to determine whether these processes activate overlapping or distinct brain regions. Although past research shows brain responses to experiencing and viewing touch, this study investigates neural processing of touch absent of visual stimulation. C-tactile (CT) nerves, present in hairy skin, respond specifically to caress-like touch. CT-targeted touch activates "social brain" regions including insula, right posterior superior temporal sulcus, amygdala, temporal poles, and orbitofrontal cortex ( McGlone et al. 2012). We addressed whether activations reflect sensory input-driven mechanisms, cognitive-based mechanisms, or both. We identified a functional dissociation between insula regions. Posterior insula responded during experienced touch. Anterior insula responded during both experienced and imagined touch. To isolate stimulus-independent mechanisms recruited during physical experience of CT-targeted touch, we identified regions active to experiencing and imagining such touch. These included amygdala and temporal pole. We posit that the dissociation of insula function suggests posterior and anterior insula involvement in distinct yet interacting processes: coding physical stimulation and affective interpretation of touch. Regions active during experiencing and imagining CT-targeted touch are associated with social processes indicating that imagining touch conjures affective aspects of experiencing such touch.

Neural systems for cognitive reappraisal in children and adolescents with autism spectrum disorder.

Despite substantial clinical and anecdotal evidence for emotion dysregulation in individuals with autism spectrum disorder (ASD), little is known about the neural substrates underlying this phenomenon. We sought to explore neural mechanisms for cognitive reappraisal in children and adolescents with ASD using functional magnetic resonance imaging (fMRI). We studied 16 youth with ASD and 15 age- and IQ-matched typically developing (TD) comparison youth. Participants were instructed in the use of cognitive reappraisal strategies to increase and decrease their emotional responses to disgusting images. Participants in both groups displayed distinct patterns of brain activity for increasing versus decreasing their emotions. TD participants showed downregulation of bilateral insula and left amygdala on decrease trials, whereas ASD participants showed no modulation of insula and upregulation of left amygdala. Furthermore, TD youth exhibited increased functional connectivity between amygdala and ventrolateral prefrontal cortex compared to ASD participants when downregulating disgust, as well as decreased functional connectivity between amygdala and orbitofrontal cortex. These findings have important implications for our understanding of emotion dysregulation and its treatment in ASD. In particular, the relative lack of prefrontal-amygdala connectivity provides a potential target for treatment-related outcome measurements.

Development of brain mechanisms for processing affective touch.

Affective tactile stimulation plays a key role in the maturation of neural circuits, but the development of brain mechanisms processing touch is poorly understood. We therefore used functional magnetic resonance imaging (fMRI) to study brain responses to soft brush stroking of both glabrous (palm) and hairy (forearm) skin in healthy children (5-13 years), adolescents (14-17 years), and adults (25-35 years). Adult-defined regions-of-interests in the primary somatosensory cortex (SI), secondary somatosensory cortex (SII), insular cortex and right posterior superior temporal sulcus (pSTS) were significantly and similarly activated in all age groups. Whole-brain analyses revealed that responses in the ipsilateral SII were positively correlated with age in both genders, and that responses in bilateral regions near the pSTS correlated significantly and strongly with age in females but not in males. These results suggest that brain mechanisms associated with both sensory-discriminative and affective-motivational aspects of touch are largely established in school-aged children, and that there is a general continuing maturation of SII and a female-specific increase in pSTS sensitivity with age. Our work establishes a groundwork for future comparative studies of tactile processing in developmental disorders characterized by disrupted social perception such as autism.

Losing face: impaired discrimination of featural and configural information in the mouth region of an inverted face.

Given that all faces share the same set of features-two eyes, a nose, and a mouth-that are arranged in similar configuration, recognition of a specific face must depend on our ability to discern subtle differences in its featural and configural properties. An enduring question in the face-processing literature is whether featural or configural information plays a larger role in the recognition process. To address this question, the face dimensions task was designed, in which the featural and configural properties in the upper (eye) and lower (mouth) regions of a face were parametrically and independently manipulated. In a same-different task, two faces were sequentially presented and tested in their upright or in their inverted orientation. Inversion disrupted the perception of featural size (Exp. 1), featural shape (Exp. 2), and configural changes in the mouth region, but it had relatively little effect on the discrimination of featural size and shape and configural differences in the eye region. Inversion had little effect on the perception of information in the top and bottom halves of houses (Exp. 3), suggesting that the lower-half impairment was specific to faces. Spatial cueing to the mouth region eliminated the inversion effect (Exp. 4), suggesting that participants have a bias to attend to the eye region of an inverted face. The collective findings from these experiments suggest that inversion does not differentially impair featural or configural face perceptions, but rather impairs the perception of information in the mouth region of the face.

fNIRS detects temporal lobe response to affective touch.

Touch plays a crucial role in social-emotional development. Slow, gentle touch applied to hairy skin is processed by C-tactile (CT) nerve fibers. Furthermore, 'social brain' regions, such as the posterior superior temporal sulcus (pSTS) have been shown to process CT-targeted touch. Research on the development of these neural mechanisms is scant, yet such knowledge may inform our understanding of the critical role of touch in development and its dysfunction in disorders involving sensory issues, such as autism. The aim of this study was to validate the ability of functional near-infrared spectroscopy (fNIRS), an imaging technique well-suited for use with infants, to measure temporal lobe responses to CT-targeted touch. Healthy adults received brushing to the right forearm (CT) and palm (non-CT) separately, in a block design procedure. We found significant activation in right pSTS and dorsolateral prefrontal cortex to arm > palm touch. In addition, individual differences in autistic traits were related to the magnitude of peak activation within pSTS. These findings demonstrate that fNIRS can detect brain responses to CT-targeted touch and lay the foundation for future work with infant populations that will characterize the development of brain mechanisms for processing CT-targeted touch in typical and atypical populations.

Social inclusion enhances biological motion processing: a functional near-infrared spectroscopy study.

Humans are especially tuned to the movements of other people. Neural correlates of this social attunement have been proposed to lie in and around the right posterior superior temporal sulcus (STS) region, which robustly responds to biological motion in contrast to a variety of non-biological motions. This response persists even when no form information is provided, as in point-light displays (PLDs). The aim of the current study was to assess the ability of functional near-infrared spectroscopy (fNIRS) to reliably measure brain responses to PLDs of biological motion, and determine the sensitivity of these responses to interpersonal contextual factors. To establish reliability, we measured brain activation to biological motion with fNIRS and functional magnetic resonance imaging (fMRI) during two separate sessions in an identical group of 12 participants. To establish sensitivity, brain responses to biological motion measured with fNIRS were subjected to an additional social manipulation where participants were either socially included or excluded before viewing PLDs of biological motion. Results revealed comparable brain responses to biological motion using fMRI and fNIRS in the right supramarginal gyrus. Further, social inclusion increased brain responses to biological motion in right supramarginal gyrus and posterior STS. Thus, fNIRS can reliably measure brain responses to biological motion and can detect social experience-dependent modulations of these brain responses.

Neural mechanisms of improvements in social motivation after pivotal response treatment: two case studies.

Pivotal response treatment (PRT) is an empirically validated behavioral treatment that has widespread positive effects on communication, behavior, and social skills in young children with autism spectrum disorder (ASD). For the first time, functional magnetic resonance imaging was used to identify the neural correlates of successful response to PRT in two young children with ASD. Baseline measures of social communication, adaptive behavior, eye tracking and neural response to social stimuli were taken prior to treatment and after 4 months of PRT. Both children showed striking gains on behavioral measures and also showed increased activation to social stimuli in brain regions utilized by typically developing children. These results suggest that neural systems supporting social perception are malleable through implementation of PRT.

Autistic traits are associated with diminished neural response to affective touch.

'Social brain' circuitry has recently been implicated in processing slow, gentle touch targeting a class of slow-conducting, unmyelinated nerves, CT afferents, which are present only in the hairy skin of mammals. Given the importance of such 'affective touch' in social relationships, the current functional magnetic resonance imaging (fMRI) study aimed to replicate the finding of 'social brain' involvement in processing CT-targeted touch and to examine the relationship between the neural response and individuals' social abilities. During an fMRI scan, 19 healthy adults received alternating blocks of slow (CT-optimal) and fast (non-optimal) brushing to the forearm. Relative to fast touch, the slow touch activated contralateral insula, superior temporal sulcus (STS), medial prefrontal cortex (mPFC), orbitofrontal cortex (OFC) and amygdala. Connectivity analyses revealed co-activation of the mPFC, insula and amygdala during slow touch. Additionally, participants' autistic traits negatively correlated with the response to slow touch in the OFC and STS. The current study replicates and extends findings of the involvement of a network of 'social brain' regions in processing CT-targeted affective touch, emphasizing the multimodal nature of this system. Variability in the brain response to such touch illustrates a tight coupling of social behavior and social brain function in typical adults.

Brain mechanisms for processing affective touch.

Despite the crucial role of touch in social development, there is very little functional magnetic resonance imaging (fMRI) research on brain mechanisms underlying social touch processing. The "skin as a social organ" hypothesis is supported by the discovery of C-tactile (CT) nerves that are present in hairy skin and project to the insular cortex. CT-fibers respond specifically well to slow, gentle touch such as that which occurs during close social interactions. Given the social significance of such touch researchers have proposed that the CT-system represents an evolutionarily conserved mechanism important for normative social development. However, it is currently unknown whether brain regions other than the insula are involved in processing CT-targeted touch. In the current fMRI study, we sought to characterize the brain regions involved in the perception of CT-supported affective touch. Twenty-two healthy adults received manual brush strokes to either the arm or palm. A direct contrast of the blood-oxygenation-level-dependent (BOLD) response to gentle brushing of the arm and palm revealed the involvement of a network of brain regions, in addition to the posterior insula, during CT-targeted affective touch to the arm. This network included areas known to be involved in social perception and social cognition, including the right posterior superior temporal sulcus and the medial prefrontal cortex (mPFC)/dorso anterior cingulate cortex (dACC). Connectivity analyses with an mPFC/dACC seed revealed coactivation with the left insula and amygdala during arm touch. These findings characterize a network of brain regions beyond the insula involved in coding CT-targeted affective touch.

The perception and identification of facial emotions in individuals with autism spectrum disorders using the Let's Face It! Emotion Skills Battery.

BACKGROUND: Although impaired social-emotional ability is a hallmark of autism spectrum disorder (ASD), the perceptual skills and mediating strategies contributing to the social deficits of autism are not well understood. A perceptual skill that is fundamental to effective social communication is the ability to accurately perceive and interpret facial emotions. To evaluate the expression processing of participants with ASD, we designed the Let's Face It! Emotion Skills Battery (LFI! Battery), a computer-based assessment composed of three subscales measuring verbal and perceptual skills implicated in the recognition of facial emotions. METHODS: We administered the LFI! Battery to groups of participants with ASD and typically developing control (TDC) participants that were matched for age and IQ. RESULTS: On the Name Game labeling task, participants with ASD (N = 68) performed on par with TDC individuals (N = 66) in their ability to name the facial emotions of happy, sad, disgust and surprise and were only impaired in their ability to identify the angry expression. On the Matchmaker Expression task that measures the recognition of facial emotions across different facial identities, the ASD participants (N = 66) performed reliably worse than TDC participants (N = 67) on the emotions of happy, sad, disgust, frighten and angry. In the Parts-Wholes test of perceptual strategies of expression, the TDC participants (N = 67) displayed more holistic encoding for the eyes than the mouths in expressive faces whereas ASD participants (N = 66) exhibited the reverse pattern of holistic recognition for the mouth and analytic recognition of the eyes. CONCLUSION: In summary, findings from the LFI! Battery show that participants with ASD were able to label the basic facial emotions (with the exception of angry expression) on par with age- and IQ-matched TDC participants. However, participants with ASD were impaired in their ability to generalize facial emotions across different identities and showed a tendency to recognize the mouth feature holistically and the eyes as isolated parts.

Disrupted action perception in autism: behavioral evidence, neuroendophenotypes, and diagnostic utility.

Disruptions in the visual perception of biological motion are emerging as a hallmark of autism spectrum disorder (ASD), consistent with the pathognomonic social deficits of this neurodevelopmental disorder. Accumulating evidence suggests an early and marked divergence in ASD from the typical developmental tuning of brain regions to process social information. In this review, we discuss a relatively recent yet substantial literature of behavioral and neuroimaging studies that consistently indicates impairments in biological motion perception in ASD. We then illustrate the fundamental disruption in this form of social perception in autism, drawing connections between a genetic liability to develop autism and disrupted associated brain mechanisms, as we describe neuroendophenotypes of autism derived from an fMRI study of biological motion perception in children with autism and their unaffected siblings. Finally, we demonstrate the diagnostic utility of brain responses to biological motion. With the ability to measure brain function in the first year of life comes the potential to chart the development of disrupted biological motion processing in ASD and to specify the gene-brain-behavior interactions shaping this atypical trajectory. We propose that a comprehensive understanding of the development of impaired responses to biological motion in ASD can inform future diagnosis and treatment approaches.

Mixed emotions: holistic and analytic perception of facial expressions.

In the face literature, it is debated whether the identification of facial expressions requires holistic (i.e., whole face) or analytic (i.e., parts-based) information. In this study, happy and angry composite expressions were created in which the top and bottom face halves formed either an incongruent (e.g., angry top + happy bottom) or congruent composite expression (e.g., happy top + happy bottom). Participants reported the expression in the target top or bottom half of the face. In Experiment 1, the target half in the incongruent condition was identified less accurately and more slowly relative to the baseline isolated expression or neutral face conditions. In contrast, no differences were found between congruent and the baseline conditions. In Experiment 2, the effects of exposure duration were tested by presenting faces for 20, 60, 100 and 120 ms. Interference effects for the incongruent faces appeared at the earliest 20 ms interval and persisted for the 60, 100 and 120 ms intervals. In contrast, no differences were found between the congruent and baseline face conditions at any exposure interval. In Experiment 3, it was found that spatial alignment impaired the recognition of incongruent expressions, but had no effect on congruent expressions. These results are discussed in terms of holistic and analytic processing of facial expressions.

Socially tuned: brain responses differentiating human and animal motion.

Typical adult observers demonstrate enhanced behavioral sensitivity to human movement compared to animal movement. Yet, the neural underpinnings of this effect are unknown. We examined the tuning of brain mechanisms for the perception of biological motion to the social relevance of this category of motion by comparing neural response to human and non-human biological motion. In particular, we tested the hypothesis that the response of the right posterior superior temporal sulcus (pSTS) varies according to the social relevance of the motion, responding most strongly to those biological motions with the greatest social relevance (human > dog). During a functional magnetic resonance imaging (fMRI) session, typical adults viewed veridical point-light displays of human, dog, and tractor motions created from motion capture data. A conjunction analysis identified regions of significant activation during biological motion perception relative to object motion. Within each of these regions, only one brain area, the right pSTS, revealed an enhanced response to human motion relative to dog motion. This finding demonstrates that the pSTS response is sensitive to the social relevance of a biological motion stimulus.

Enhanced neural responses to rule violation in children with autism: a comparison to social exclusion.

The present study aimed to explore the neural correlates of two characteristic deficits in autism spectrum disorders (ASD); social impairment and restricted, repetitive behavior patterns. To this end, we used comparable experiences of social exclusion and rule violation to probe potentially atypical neural networks in ASD. In children and adolescents with and without ASD, we used the interactive ball-toss game (Cyberball) to elicit social exclusion and a comparable game (Cybershape) to elicit a non-exclusive rule violation. Using functional magnetic resonance imaging (fMRI), we identified group differences in brain responses to social exclusion and rule violation. Though both groups reported equal distress following exclusion, the right insula and ventral anterior cingulate cortex were hypoactive during exclusion in children with ASD. In rule violation, right insula and dorsal prefrontal cortex were hyperactive in ASD. Right insula showed a dissociation in activation; it was hypoactive to social exclusion and hyperactive to rule violation in the ASD group. Further probed, different regions of right insula were modulated in each game, highlighting differences in regional specificity for which subsequent analyses revealed differences in patterns of functional connectivity. These results demonstrate neurobiological differences in processing social exclusion and rule violation in children with ASD.

How grossed out are you? The neural bases of emotion regulation from childhood to adolescence.

The ability to regulate one's emotions is critical to mental health and well-being, and is impaired in a wide range of psychopathologies, some of which initially manifest in childhood or adolescence. Cognitive reappraisal is a particular approach to emotion regulation frequently utilized in behavioral psychotherapies. Despite a wealth of research on cognitive reappraisal in adults, little is known about the developmental trajectory of brain mechanisms subserving this form of emotion regulation in children. In this functional magnetic resonance imaging study, we asked children and adolescents to up-and down-regulate their response to disgusting images, as the experience of disgust has been linked to anxiety disorders. We demonstrate distinct patterns of brain activation during successful up- and down-regulation of emotion, as well as an inverse correlation between activity in ventromedial prefrontal cortex (vmPFC) and limbic structures during down-regulation, suggestive of a potential regulatory role for vmPFC. Further, we show age-related effects on activity in PFC and amygdala. These findings have important clinical implications for the understanding of cognitive-based therapies in anxiety disorders in childhood and adolescence.

Neural signatures of autism.

Functional magnetic resonance imaging of brain responses to biological motion in children with autism spectrum disorder (ASD), unaffected siblings (US) of children with ASD, and typically developing (TD) children has revealed three types of neural signatures: (i) state activity, related to the state of having ASD that characterizes the nature of disruption in brain circuitry; (ii) trait activity, reflecting shared areas of dysfunction in US and children with ASD, thereby providing a promising neuroendophenotype to facilitate efforts to bridge genomic complexity and disorder heterogeneity; and (iii) compensatory activity, unique to US, suggesting a neural system-level mechanism by which US might compensate for an increased genetic risk for developing ASD. The distinct brain responses to biological motion exhibited by TD children and US are striking given the identical behavioral profile of these two groups. These findings offer far-reaching implications for our understanding of the neural systems underlying autism.