Extra-axial cerebrospinal fluid in high-risk and normal-risk children with autism aged 2-4 years: a case-control study.

BACKGROUND: We previously showed, in two separate cohorts, that high-risk infants who were later diagnosed with autism spectrum disorder had abnormally high extra-axial cerebrospinal fluid (CSF) volume from age 6-24 months. The presence of increased extra-axial CSF volume preceded the onset of behavioural symptoms of autism and was predictive of a later diagnosis of autism spectrum disorder. In this study, we aimed to establish whether increased extra-axial CSF volume is found in a large, independent sample of children diagnosed with autism spectrum disorder, whether extra-axial CSF remains abnormally increased beyond infancy, and whether it is present in both normal-risk and high-risk children with autism. METHODS: In this case-control MRI study, children with autism spectrum disorder or with typical development aged 2-4 years were recruited from the community to the UC Davis MIND Institute Autism Phenome Project, based in Sacramento, CA, USA. The autism spectrum disorder group comprised children with autism spectrum disorder who were either normal risk (ie, from simplex families) or high risk (ie, from multiplex families). Measurements of extra-axial CSF volume, brain volume, head circumference, sleep problems, and familial risk status were derived from MRI and behavioural assessments. We applied a previously validated machine learning algorithm based on extra-axial CSF volume, brain volume, age, and sex to the current dataset. FINDINGS: Between July 20, 2007, and Dec 13, 2012, 159 children with autism spectrum disorder (132 male, 27 female) and 77 with typical development (49 male, 28 female) underwent MRI scans. The autism spectrum disorder group had an average of 15·1% more extra-axial CSF than controls after accounting for differences in brain volume, weight, age, and sex (least-squares mean 116·74 cm3 [SE 3·33] in autism group vs 101·40 cm3 [3·93] in typical development group; p=0·007; Cohen's d = 0·39). Subgroups of normal-risk (n=132) and high-risk (n=27) children with autism spectrum disorder had nearly identical extra-axial CSF volumes (p=0·78), and both subgroups had significantly greater volumes than controls. Both extra-axial CSF volume (p=0·004) and brain volume (p<0·0001) uniquely contributed to enlarged head circumference in the autism spectrum disorder group (p=0·04). Increased extra-axial CSF volume was associated with greater sleep disturbances (p=0·03) and lower non-verbal ability (p=0·04). The machine learning algorithm correctly predicted autism spectrum disorder diagnosis with a positive predictive value of 83% (95% CI 76·2-88·3). INTERPRETATION: Increased extra-axial CSF volume is a reliable brain anomaly that has now been found in three independent cohorts, comprising both high-risk and normal-risk children with autism spectrum disorder. Increased extra-axial CSF volume is detectable using conventional structural MRI scans from infancy through to age 3 years. These results suggest that increased extra-axial CSF volume could be an early stratification biomarker of a biologically based subtype of autism that might share a common underlying pathophysiology. FUNDING: US National Institutes of Health.

Naturalistic Language Recordings Reveal "Hypervocal" Infants at High Familial Risk for Autism.

Children's early language environments are related to later development. Little is known about this association in siblings of children with autism spectrum disorder (ASD), who often experience language delays or have ASD. Fifty-nine 9-month-old infants at high or low familial risk for ASD contributed full-day in-home language recordings. High-risk infants produced more vocalizations than low-risk peers; conversational turns and adult words did not differ by group. Vocalization differences were driven by a subgroup of "hypervocal" infants. Despite more vocalizations overall, these infants engaged in less social babbling during a standardized clinic assessment, and they experienced fewer conversational turns relative to their rate of vocalizations. Two ways in which these individual and environmental differences may relate to subsequent development are discussed.

Walking, Gross Motor Development, and Brain Functional Connectivity in Infants and Toddlers.

Infant gross motor development is vital to adaptive function and predictive of both cognitive outcomes and neurodevelopmental disorders. However, little is known about neural systems underlying the emergence of walking and general gross motor abilities. Using resting state fcMRI, we identified functional brain networks associated with walking and gross motor scores in a mixed cross-sectional and longitudinal cohort of infants at high and low risk for autism spectrum disorder, who represent a dimensionally distributed range of motor function. At age 12 months, functional connectivity of motor and default mode networks was correlated with walking, whereas dorsal attention and posterior cingulo-opercular networks were implicated at age 24 months. Analyses of general gross motor function also revealed involvement of motor and default mode networks at 12 and 24 months, with dorsal attention, cingulo-opercular, frontoparietal, and subcortical networks additionally implicated at 24 months. These findings suggest that changes in network-level brain-behavior relationships underlie the emergence and consolidation of walking and gross motor abilities in the toddler period. This initial description of network substrates of early gross motor development may inform hypotheses regarding neural systems contributing to typical and atypical motor outcomes, as well as neurodevelopmental disorders associated with motor dysfunction.

Resting-state fMRI in sleeping infants more closely resembles adult sleep than adult wakefulness.

Resting state functional magnetic resonance imaging (rs-fMRI) in infants enables important studies of functional brain organization early in human development. However, rs-fMRI in infants has universally been obtained during sleep to reduce participant motion artifact, raising the question of whether differences in functional organization between awake adults and sleeping infants that are commonly attributed to development may instead derive, at least in part, from sleep. This question is especially important as rs-fMRI differences in adult wake vs. sleep are well documented. To investigate this question, we compared functional connectivity and BOLD signal propagation patterns in 6, 12, and 24 month old sleeping infants with patterns in adult wakefulness and non-REM sleep. We find that important functional connectivity features seen during infant sleep closely resemble those seen during adult sleep, including reduced default mode network functional connectivity. However, we also find differences between infant and adult sleep, especially in thalamic BOLD signal propagation patterns. These findings highlight the importance of considering sleep state when drawing developmental inferences in infant rs-fMRI.

Functional neuroimaging of high-risk 6-month-old infants predicts a diagnosis of autism at 24 months of age.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by social deficits and repetitive behaviors that typically emerge by 24 months of age. To develop effective early interventions that can potentially ameliorate the defining deficits of ASD and improve long-term outcomes, early detection is essential. Using prospective neuroimaging of 59 6-month-old infants with a high familial risk for ASD, we show that functional connectivity magnetic resonance imaging correctly identified which individual children would receive a research clinical best-estimate diagnosis of ASD at 24 months of age. Functional brain connections were defined in 6-month-old infants that correlated with 24-month scores on measures of social behavior, language, motor development, and repetitive behavior, which are all features common to the diagnosis of ASD. A fully cross-validated machine learning algorithm applied at age 6 months had a positive predictive value of 100% [95% confidence interval (CI), 62.9 to 100], correctly predicting 9 of 11 infants who received a diagnosis of ASD at 24 months (sensitivity, 81.8%; 95% CI, 47.8 to 96.8). All 48 6-month-old infants who were not diagnosed with ASD were correctly classified [specificity, 100% (95% CI, 90.8 to 100); negative predictive value, 96.0% (95% CI, 85.1 to 99.3)]. These findings have clinical implications for early risk assessment and the feasibility of developing early preventative interventions for ASD.

Increased Extra-axial Cerebrospinal Fluid in High-Risk Infants Who Later Develop Autism.

BACKGROUND: We previously reported that infants who developed autism spectrum disorder (ASD) had increased cerebrospinal fluid (CSF) in the subarachnoid space (i.e., extra-axial CSF) from 6 to 24 months of age. We attempted to confirm and extend this finding in a larger independent sample. METHODS: A longitudinal magnetic resonance imaging study of infants at risk for ASD was carried out on 343 infants, who underwent neuroimaging at 6, 12, and 24 months. Of these infants, 221 were at high risk for ASD because of an older sibling with ASD, and 122 were at low risk with no family history of ASD. A total of 47 infants were diagnosed with ASD at 24 months and were compared with 174 high-risk and 122 low-risk infants without ASD. RESULTS: Infants who developed ASD had significantly greater extra-axial CSF volume at 6 months compared with both comparison groups without ASD (18% greater than high-risk infants without ASD; Cohen's d = 0.54). Extra-axial CSF volume remained elevated through 24 months (d = 0.46). Infants with more severe autism symptoms had an even greater volume of extra-axial CSF from 6 to 24 months (24% greater at 6 months, d = 0.70; 15% greater at 24 months, d = 0.70). Extra-axial CSF volume at 6 months predicted which high-risk infants would be diagnosed with ASD at 24 months with an overall accuracy of 69% and corresponding 66% sensitivity and 68% specificity, which was fully cross-validated in a separate sample. CONCLUSIONS: This study confirms and extends previous findings that increased extra-axial CSF is detectable at 6 months in high-risk infants who develop ASD. Future studies will address whether this anomaly is a contributing factor to the etiology of ASD or an early risk marker for ASD.

Subcortical Brain and Behavior Phenotypes Differentiate Infants With Autism Versus Language Delay.

BACKGROUND: Younger siblings of children with autism spectrum disorder (ASD) are themselves at increased risk for ASD and other developmental concerns. It is unclear if infants who display developmental concerns, but are unaffected by ASD, share similar or dissimilar behavioral and brain phenotypes to infants with ASD. Most individuals with ASD exhibit heterogeneous difficulties with language, and their receptive-expressive language profiles are often atypical. Yet, little is known about the neurobiology that contributes to these language difficulties. METHODS: In this study, we used behavioral assessments and structural magnetic resonance imaging to investigate early brain structures and associations with later language skills. High-risk infants who were later diagnosed with ASD (n = 86) were compared with high-risk infants who showed signs of early language delay (n = 41) as well as with high- and low-risk infants who did not have ASD or language delay (n = 255 and 143, respectively). RESULTS: Results indicated that diminished language skills were evident at 12 months in infants with ASD and infants with early language delay. At 24 months of age, only the infants with ASD displayed atypical receptive-expressive language profiles. Associations between 12-month subcortical volumes and 24-month language skills were moderated by group status, indicating disordinal brain-behavior associations among infants with ASD and infants with language delay. CONCLUSIONS: These results suggest that there are different brain mechanisms influencing language development in infants with ASD and infants with language delay, and that the two groups likely experience unique sets of genetic and environmental risk factors.

Longitudinal Study of the Emerging Functional Connectivity Asymmetry of Primary Language Regions during Infancy.

Asymmetry in the form of left-hemisphere lateralization is a striking characteristic of the cerebral regions involved in the adult language network. In this study, we leverage a large sample of typically developing human infants with longitudinal resting-state functional magnetic resonance imaging scans to delineate the trajectory of interhemispheric functional asymmetry in language-related regions during the first 2 years of life. We derived the trajectory of interhemispheric functional symmetry of the inferior frontal gyrus (IFG) and superior temporal gyrus (STG), the sensory and visual cortices, and two higher-order regions within the intraparietal sulcus and dorsolateral prefrontal cortex. Longitudinal models revealed a best fit with quadratic age terms and showed significant estimated coefficients of determination for both the IFG (r2 = 0.261, p < 0.001) and the STG (r2 = 0.142, p < 0.001) regions while all other regions were best modeled by log-linear increases. These inverse-U-shaped functions of the language regions peaked at ∼11.5 months of age, indicating that a transition toward asymmetry began in the second year. This shift was accompanied by an increase in the functional connectivity of these regions within the left hemisphere. Finally, we detected an association between the trajectory of the IFG and language outcomes at 4 years of age (χ2 = 10.986, p = 0.011). Our results capture the developmental timeline of the transition toward interhemispheric functional asymmetry during the first 2 years of life. More generally, our findings suggest that increasing interhemispheric functional symmetry in the first year might be a general principle of the developing brain, governing different functional systems, including those that will eventually become lateralized in adulthood. SIGNIFICANCE STATEMENT: Cross-sectional studies of the language system in early infancy suggest that the basic neural mechanisms are in place even before birth. This study represents the first of its kind, using a large longitudinal sample of infants, to delineate the early language-related transition toward interhemispheric functional asymmetry in the brain using resting-state functional MRI. More generally, our findings suggest that increasing interhemispheric functional symmetry in the first year might be a general principle of the developing brain governing multiple functional systems, including those that will eventually become lateralized in adulthood. Although resting-state functional MRI cannot provide direct insights into the developmental mechanisms of language lateralization, this study reveals language-related functional connectivity changes during infancy, marking critical points in the development of the brain's functional architecture.

Network-Level Connectivity Dynamics of Movie Watching in 6-Year-Old Children.

Better understanding of the developing brain's functional mechanisms is critical for improving diagnosis and treatment of different developmental disorders. Particularly, characterizing how the developing brain dynamically reorganizes during different cognitive states may offer novel insight into the neuronal mechanisms of cognitive deficits. Imaging the brain during naturalistic conditions, like movie watching, provides a highly practical way to study young children's developing functional brain systems. In this study we compared the network-level functional organization of 6-year-old children while they were at rest with their functional connectivity as they watched short video clips. We employed both a data-driven independent component analysis (ICA) approach and a hypothesis-driven seed-based analysis to identify changes in network-level functional interactions during the shift from resting to video watching. Our ICA results showed that naturally watching a movie elicits significant changes in the functional connectivity between the visual system and the dorsal attention network when compared to rest (t (32) = 5.02, p = 0.0001). More interestingly, children showed an immature, but qualitatively adult-like, pattern of reorganization among three of the brain's higher-order networks (frontal control, default-mode and dorsal attention). For both ICA and seed-based approaches, we observed a decrease in the frontal network's correlation with the dorsal attention network (ICA: t (32) = -2.46, p = 0.02; Seed-based: t (32) = -1.62, p =0.12) and an increase in its connectivity with the default mode network (ICA: t (32) = 2.84, p = 0.008; Seed-based: t (32) = 2.28, p =0.03), which is highly consistent with the pattern observed in adults. These results offer improved understanding of the developing brain's dynamic network-level interaction patterns during the transition between different brain states and call for further studies to examine potential alterations to such dynamic patterns in different developmental disorders.

Design and Testing of a Bionic Dancing Prosthesis.

Traditionally, prosthetic leg research has focused on improving mobility for activities of daily living. Artistic expression such as dance, however, is not a common research topic and consequently prosthetic technology for dance has been severely limited for the disabled. This work focuses on investigating the ankle joint kinetics and kinematics during a Latin-American dance to provide unique motor options for disabled individuals beyond those of daily living. The objective of this study was to develop a control system for a bionic ankle prosthesis that outperforms conventional prostheses when dancing the rumba. The biomechanics of the ankle joint of a non-amputee, professional dancer were acquired for the development of the bionic control system. Subsequently, a professional dancer who received a traumatic transtibial amputation in April 2013 tested the bionic dance prosthesis and a conventional, passive prosthesis for comparison. The ability to provide similar torque-angle behavior of the biological ankle was assessed to quantify the biological realism of the prostheses. The bionic dancing prosthesis overlapped with 37 ± 6% of the non-amputee ankle torque and ankle angle data, compared to 26 ± 2% for the conventional, passive prosthesis, a statistically greater overlap (p = 0.01). This study lays the foundation for quantifying unique, expressive activity modes currently unavailable to individuals with disabilities. Future work will focus on an expansion of the methods and types of dance investigated in this work.

Continuity and change in children's longitudinal neural responses to numbers.

Human children possess the ability to approximate numerical quantity nonverbally from a young age. Over the course of early childhood, children develop increasingly precise representations of numerical values, including a symbolic number system that allows them to conceive of numerical information as Arabic numerals or number words. Functional brain imaging studies of adults report that activity in bilateral regions of the intraparietal sulcus (IPS) represents a key neural correlate of numerical cognition. Developmental neuroimaging studies indicate that the right IPS develops its number-related neural response profile more rapidly than the left IPS during early childhood. One prediction that can be derived from previous findings is that there is longitudinal continuity in the number-related neural responses of the right IPS over development while the development of the left IPS depends on the acquisition of numerical skills. We tested this hypothesis using fMRI in a longitudinal design with children ages 4 to 9. We found that neural responses in the right IPS are correlated over a 1-2-year period in young children whereas left IPS responses change systematically as a function of children's numerical discrimination acuity. The data are consistent with the hypothesis that functional properties of the right IPS in numerical processing are stable over early childhood whereas the functions of the left IPS are dynamically modulated by the development of numerical skills.

Early math achievement and functional connectivity in the fronto-parietal network.

In this study we test the hypothesis that the functional connectivity of the frontal and parietal regions that children recruit during a basic numerical task (matching Arabic numerals to arrays of dots) is predictive of their math test scores (TEMA-3; Ginsburg, 2003). Specifically, we tested 4-11-year-old children on a matching task during fMRI to localize a fronto-parietal network that responds more strongly during numerical matching than matching faces, words, or shapes. We then tested the functional connectivity between those regions during an independent task: natural viewing of an educational video that included math topics. Using this novel natural viewing method, we found that the connectivity between frontal and parietal regions during task-independent free-viewing of educational material is correlated with children's basic number matching ability, as well as their scores on the standardized test of mathematical ability (the TEMA). The correlation between children's mathematics scores and fronto-parietal connectivity is math-specific in the sense that it is independent of children's verbal IQ scores. Moreover, a control network, selective for faces, showed no correlation with mathematics performance. Finally, brain regions that correlate with subjects' overall response times in the matching task do not account for our number- and math-related effects. We suggest that the functional intersection of number-related frontal and parietal regions is math-specific.