"A perfect storm": Autistic experiences of menopause and midlife.

LAY ABSTRACT: Previous studies report that menopause can be a very difficult transition for some autistic people. This study focuses on how autistic people experience menopause and what support and information might help them. Autistic Community Research Associates played an important role in the research and co-authored this article. We held four focus groups and eight interviews online with 24 autistic participants who lived in either Canada (n = 13) or the United Kingdom (n = 11). We analysed participant conversations using a method called reflexive thematic analysis. Participants described many intense challenges during menopause. Four themes and eight subthemes were identified across participant groups: (1) Complexity, multiplicity and intensity of symptoms (0 subthemes); (2) Life experience and adversity converging at midlife (three subthemes); (3) The importance of knowledge and connection (two subthemes); and (4) Barriers to support and care (three subthemes). The experiences of our participants may not be the same as other autistic people, and the study could have been more inclusive of diverse autistic groups. However, hearing about the experiences of others may provide reassurance to autistic people who struggle with menopause and let them know they are not alone.

Potential Mechanisms Underlying Suicidality in Autistic People with Attention Deficit/Hyperactivity Disorder: Testing Hypotheses from the Interpersonal Theory of Suicide.

Background: Autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) appear to be at heightened risk of suicide. To understand why, we explored two explanatory mechanisms from the interpersonal theory of suicide: first, that co-occurring ADHD might be associated with greater risk through greater thwarted belongingness and perceived burdensomeness and, secondly, that hyperactive/impulsive features might incur additional risk through their association with painful and provocative events, which are suggested to create "capability" for suicide. Methods: Autistic adults (n = 314) completed an online survey including measures of thwarted belongingness, perceived burdensomeness, painful and provocative events, acquired capability for suicide, and ADHD features. Creating an overall index of likely ADHD, we examined associations between likely ADHD, suicide ideation, and lifetime suicide attempts through the parallel mediators of thwarted belongingness, perceived burdensomeness, anxiety, and depression. In several models, we then examined hyperactive, impulsive, and inattentive features as predictors of exposure to painful and provocative events and subsequent capability for suicide, and examined whether these two variables, sequentially or individually, mediated an association with lifetime suicide attempts. Results: Likely ADHD was associated with past-year suicide ideation through greater depression and perceived burdensomeness, which also mediated its association with more suicide attempts. Hyperactive and impulsive features were associated with exposure to painful and provocative events and through this acquired suicide capability. Both features were associated with more numerous suicide attempts through these two mediators sequentially, and through exposure to painful and provocative events alone. Conclusions: These data suggest that suicidality in autistic people with ADHD may be partially related to perceived burdensomeness and to acquired suicide capability after exposure to painful and provocative events. However, as we observed a pathway to suicidality associated with painful and provocative events alone, it is likely that there are also other explanatory mechanisms for the influence of traumatic events on suicide risk.

Why is this an important issue?: Suicide is a leading cause of premature death in autistic people, but we still know little about why autistic people are at greater risk and how we can help. Recent findings suggest that autistic people with co-occurring attention deficit/hyperactivity disorder (ADHD) are at even higher risk, but we do not yet understand why. What was the purpose of this study?: This research examined two potential explanations for higher risk of suicide in autistic people with co-occurring ADHD. First, we expected that because these individuals are often very isolated and struggle with independence and employment, they might be more vulnerable to two risk factors for suicide: "thwarted belongingness," the feeling of being alienated from other people, and "perceived burdensomeness," the feeling that one is a burden to others. We also expected that hyperactive/impulsive features associated with ADHD might make people more likely to experience painful and dangerous events. Exposure to events like this is suggested to make people less frightened of dying by suicide and more able to attempt to end their lives. This is called "acquiring capability" for suicide. What did the researchers do?: We asked 314 autistic adults to complete an online survey including measures of thwarted belongingness, perceived burdensomeness, exposure to painful and dangerous events, and acquired capability for suicide. They also completed a scale measuring ADHD features, and symptoms of depression and anxiety. We then looked at which of these factors, if any, explained suicide risk in autistic people with co-occurring ADHD. What were the results of the study?: Our data suggest that autistic people with co-occurring ADHD might be at greater risk of suicide ideation and attempts because they are more likely to experience depression and to feel like a burden to others. We also found that people with high degrees of hyperactive/impulsive features were more likely to experience painful and dangerous events, and, therefore, had greater capability for suicide­because of this, they were more likely to have attempted suicide more times in the past. Exposure to these kinds of traumatic events also increased the risk of suicide all by itself. What do these findings add to what was already known?: Very little is known about why autistic people with co-occurring ADHD might be at even higher risk of suicide than people with either ADHD or autism alone. No studies have examined explanations for suicide in this subgroup. What are potential weaknesses in the study?: Because this study looked at a snapshot of participants' current states, we cannot be sure of the direction of relationships between variables. For example, it might be that experiences of surviving suicide attempts actually make people feel more depressed and more like a burden afterward, rather than these feelings being the risk factors that contributed to suicide attempts. How will these findings help autistic adults now or in the future?: These findings indicate feelings and experiences that are relevant to suicide risk in autistic people with co-occurring ADHD, which might thus be important to target in interventions.

'Welcome to my world': a thematic analysis of the lived experiences of people with Myalgic Encephalomyelitis during the UK COVID-19 lockdown.

OBJECTIVES: We explore the experiences of people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (pwME/CFS) during the first UK COVID-19 lockdown period. We specifically probe perceived commonalities and departures in experience between government- and health-imposed lockdowns, application of coping strategies for social isolation, and predictions for inclusion of the chronically ill in post-pandemic society. METHODS AND MEASURES: Thirty semi-structured interviews were conducted in pwME/CFS between June - July, 2020. Responses were qualitatively analysed using an experiential, thematic framework. RESULTS: While participants reported enhancements in digital accessibility during lockdown, they perceived this as an unintentional benefit from changes designed to cater universally. Similarly, their expectation was that the general population's limited experience of restriction would not engender greater understanding for those who would continue to experience health-imposed lockdowns, post-pandemic. Participants described numerous strategies for coping with restriction and isolation, developed during prior health-imposed lockdowns and applied to this novel circumstance, highlighting the presence of acceptance and resilience in the sample. CONCLUSIONS: Our findings suggest that future work may fruitfully examine whether our participant's predictions for post-pandemic societal inclusion have been met, and how resilience and acceptance might be developed and nurtured in chronically ill populations through times of adversity.

Non-suicidal self-injury and its relation to suicide through acquired capability: investigating this causal mechanism in a mainly late-diagnosed autistic sample.

BACKGROUND: Non-suicidal self-injury (NSSI) has been linked with a higher risk of suicide attempts in autistic and non-autistic people. In the general population, NSSI may confer acquired capability for suicide by eroding one's fear and avoidance of pain and death. The present study aimed to explore acquired capability as the mediator of increased suicide risk conferred by NSSI in autistic and non-autistic adults. METHODS: Autistic and non-autistic adults (n = 314, n = 312) completed an online survey exploring lifetime suicide attempts, experience with NSSI, and acquired capability for suicide. We explored relationships between lifetime incidence of NSSI and lifetime suicide attempts via three facets of acquired capability (pain tolerance, reduced fear of death, and mental rehearsal of suicide). In self-harming participants (224 autistic and 156 non-autistic), we explored whether particular types and features of NSSI might be especially associated with capability and through that with suicide: namely engagement in scratching, cutting, and self-hitting, and engaging in more numerous forms of NSSI. RESULTS: While a higher frequency of NSSI was associated with all three facets of acquired capability, only reduced fear of death and mental rehearsal of suicide mediated an indirect relationship with lifetime suicide attempts. NSSI also directly predicted more numerous suicide attempts. Autistic people tended towards reduced fear of death and mental rehearsal regardless of NSSI status. Among self-harming autistic and non-autistic participants, cutting and an increased number of NSSI behaviours were associated with lifetime suicide attempts directly and indirectly via acquired capability. In both groups, self-hitting was associated with lifetime suicide attempts only via acquired capability. LIMITATIONS: Our cross-sectional methodology negates inferences of directionality. While we controlled for age, our samples were poorly matched, with the autistic group two times older on average. The autistic sample, predominantly late-diagnosed, female and highly qualified, were unrepresentative of the whole autistic community. CONCLUSIONS: Our data suggest that acquired capability, as measured herein, is an incomplete explanation for the association between NSSI and suicide risk. A broader construct with stable and transient facets may offer greater explanatory power, but it is probable that other variables explain or provide additional means through which this association arises.

Conceptualisations of health in orthorexia nervosa: a mixed-methods study.

PURPOSE: Limited research has explored conceptualisations of health and healthy eating in orthorexia nervosa (ON). This mixed-methods study aimed to investigate how 'health' and 'healthy eating' are conceptualised by individuals at risk for ON. This study examined the potential relationships between health anxiety, beliefs about health controllability and orthorexic symptomatology in our broader sample. METHODS: A total of 362 participants took a survey on health anxiety (measured with the HAQ), beliefs about the controllability of one's own health (IMHLC) and ON symptomatology (E-DOS and EHQ). Participants 'at risk' for ON (n = 141), also completed an online qualitative survey about conceptualisations of health and healthy eating. Qualitative data were analysed using thematic analysis (part A). The PROCESS macro for SPSS was used for the quantitative analysis (part B). RESULTS: Conceptualisations of health and healthy eating were complex. Four themes were generated from our qualitative data: 'health is more than thin ideals', 'healthy food equals healthy mind', 'a body that works for you' and 'taking control of your body'. Our quantitative analysis revealed that health anxiety and beliefs in health controllability independently predicted ON symptomatology. CONCLUSION: A richer understanding of what health means in the context of ON is important, given the centrality of this concept to the proposed classification of this disordered eating style. Our findings highlight that both health anxiety and health controllability are important targets for future investigation, given their potential relevance to the aetiology and treatment of ON. LEVEL OF EVIDENCE: Level V, based on a descriptive study.

Lifetime and perceived stress, social support, loneliness, and health in autistic adults.

OBJECTIVES: Although the health consequences of life stress exposure in the general population are well known, how different stressors occurring over the lifetime cause morbidity and mortality in autism is unclear, as are the factors that moderate and mediate these associations. The few studies that have compared autistic and nonautistic individuals have used instruments that yield few stress exposure indices and assess stressors occurring over short time periods. METHOD: To address these issues, we used the Stress and Adversity Inventory to assess lifetime stressor exposure and perceived stressor severity in 127 autistic and 104 nonautistic adults. Moderated mediation analysis examined associations between stressor exposure and physical and mental ill-health with respect to the hypothesized mediating role of stressor perception, and moderation effects of loneliness and social support. RESULTS: Autistic adults experienced more lifetime stressors and generally perceived stressors as being more severe. Greater perceived stressor severity was related to poorer physical and mental health and to greater loneliness and lower social support for both groups. An additional post hoc analysis of the association between diagnostic status and mental ill-health revealed that loneliness mediated the relation between being autistic and having poorer mental health. CONCLUSION: Autistic individuals experienced more lifetime stressors, and their impact on physical and mental health was mediated by perceived stressor severity. Moreover, loneliness and low social support were associated with greater negative impact of lifetime stress exposure on mental health. Interventions that reduce cognitive-perceptual stress appraisals, and that target loneliness and social support, may help reduce risk for stress-related disease in autistic individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Autism research is 'all about the blokes and the kids': Autistic women breaking the silence on menopause.

OBJECTIVES: The menopause is a major transition marked by considerable challenges to health and well-being. Its impact on autistic women has been almost largely ignored but is of significant concern, given the poorer physical and mental health, emotion regulation and coping skills, and the common social isolation of this group. We aimed to explore awareness and perception of the menopause; menopausal experiences and their impact across each individual's life; ways that menopause with autism might differ from a non-autistic menopause; and what optimal support might look like. DESIGN: A qualitative interview study. METHODS: Comprehensive interviews were conducted with 17 autistic participants (16 of whom identified as cisgender women). Inductive thematic analysis was used, guided by IPA principles and literature. RESULTS: Four major themes were identified: (1) covering the long journey of our participants to recognizing autism in adulthood; (2) menopausal awareness and perceptions; (3) symptoms and their impact; and (4) ways that a neurodiverse menopause might differ from the norm. Menopausal experiences varied greatly and some participants experienced marked deterioration in daily function and coping skills, mental health, and social engagement. Menopausal awareness was often low, so too was confidence in help from health care professionals. CONCLUSIONS: These findings implicate the potential for menopause to severely compromise health and well-being of autistic people and indicate an area of underserved support needs.

'When my autism broke': A qualitative study spotlighting autistic voices on menopause.

LAY ABSTRACT: Autistic girls are known to struggle with the onset of menstruation, reporting that during their period, sensory sensitivities are heightened, it becomes more difficult to think clearly and control their emotions and they struggle more with everyday life and self-care. Yet surprisingly, nothing is known about how autistic women handle the menopausal transition in midlife. In non-autistic women, the menopause brings many physical changes and challenging symptoms from hot flushes to feeling more anxious and depressed. Because autistic women are already vulnerable to suicide, poor physical and mental health, and because they may already struggle with planning, controlling their emotions and coping with change, the menopause may be an especially challenging time. Yet, not one single study exists on the menopause in autism, so we conducted an online discussion (focus group) with seven autistic women. They confirmed that very little is known about menopause in autistic people, very little support is available and that menopause might be especially difficult for autistic people. Autism-related difficulties (including sensory sensitivity, socializing with others and communicating needs) were reported to worsen during the menopause, often so dramatically that some participants suggested they found it impossible to continue to mask their struggles. Participants also reported having extreme meltdowns, experiencing anxiety and depression, and feeling suicidal. This study highlights how important it is that professionals pay attention to menopause in autism, and discusses future research directions.

Prediction and Mismatch Negativity Responses Reflect Impairments in Action Semantic Processing in Adults With Autism Spectrum Disorders.

The neurophysiological mechanisms underlying motor and language difficulties in autism spectrum disorders (ASD) are still largely unclear. The present work investigates biological indicators of sound processing, (action-) semantic understanding and predictive coding and their correlation with clinical symptoms of ASD. Twenty-two adults with high-functioning ASD and 25 typically developed (TD) participants engaged in an auditory, passive listening, Mismatch Negativity (MMN) task while high-density electroencephalography (EEG) was recorded. Action and non-action words were presented in the context of sounds, which were either semantically congruent with regard to the body part they relate to or semantically incongruent or unrelated. The anticipatory activity before sound onset, the Prediction Potential (PP), was significantly reduced in the ASD group specifically for action, but not for non-action sounds. The early-MMN-like responses to words (latency: 120 ms) were differentially modulated across groups: controls showed larger amplitudes for words in action-sound compared to non-action contexts, whereas ASD participants demonstrated enlarged early-MMN-like responses only in a pure tone context, with no other modulation dependent on action sound context. Late-MMN-like responses around 560 ms post-stimulus onset revealed body-part-congruent action-semantic priming for words in control participants, but not in the ASD group. Importantly, neurophysiological indices of semantic priming in ASD participants correlated with the extent of autistic traits as revealed by the Autism Spectrum Quotient (AQ). The data suggest that high-functioning adults with ASD show a specific deficit in semantic processing and predictive coding of sounds and words related to action, which is absent for neutral, non-action, sounds.

What can autism teach us about the role of sensorimotor systems in higher cognition? New clues from studies on language, action semantics, and abstract emotional concept processing.

Within the neurocognitive literature there is much debate about the role of the motor system in language, social communication and conceptual processing. We suggest, here, that autism spectrum conditions (ASC) may afford an excellent test case for investigating and evaluating contemporary neurocognitive models, most notably a neurobiological theory of action perception integration where widely-distributed cell assemblies linking neurons in action and perceptual brain regions act as the building blocks of many higher cognitive functions. We review a literature of functional motor abnormalities in ASC, following this with discussion of their neural correlates and aberrancies in language development, explaining how these might arise with reference to the typical formation of cell assemblies linking action and perceptual brain regions. This model gives rise to clear hypotheses regarding language comprehension, and we highlight a recent set of studies reporting differences in brain activation and behaviour in the processing of action-related and abstract-emotional concepts in individuals with ASC. At the neuroanatomical level, we discuss structural differences in long-distance frontotemporal and frontoparietal connections in ASC, such as would compromise information transfer between sensory and motor regions. This neurobiological model of action perception integration may shed light on the cognitive and social-interactive symptoms of ASC, building on and extending earlier proposals linking autistic symptomatology to motor disorder and dysfunction in action perception integration. Further investigating the contribution of motor dysfunction to higher cognitive and social impairment, we suggest, is timely and promising as it may advance both neurocognitive theory and the development of new clinical interventions for this population and others characterised by early and pervasive motor disruption.

Default Mode Hypoconnectivity Underlies a Sex-Related Autism Spectrum.

BACKGROUND: Females and males differ significantly in the prevalence and presentation of autism spectrum conditions. One theory of this effect postulates that autistic traits lie on a sex-related continuum in the general population, and autism represents the extreme male end of this spectrum. This theory predicts that any feature of autism in males should 1) be present in autistic females, 2) differentiate between the sexes in the typical population, and 3) correlate with autistic traits. We tested these three predictions for default mode network (DMN) hypoconnectivity during the resting state, one of the most robustly found neurobiological differences in autism. METHODS: We analyzed a primary dataset of adolescents (N = 121, 12-18 years of age) containing a relatively large number of females and a replication multisite dataset including children, adolescents, and adults (N = 980, 6-58 years of age). We quantified the average connectivity between DMN regions and tested for group differences and correlation with behavioral performance using robust regression. RESULTS: We found significant differences in DMN intraconnectivity between female controls and females with autism (p = .001 in the primary dataset; p = .009 in the replication dataset), and between female controls and male controls (p = .036 in the primary dataset; p = .002 in the replication dataset). We also found a significant correlation between DMN intraconnectivity and performance on a mentalizing task (p = .001) in the primary dataset. CONCLUSIONS: Collectively, these findings provide the first evidence for DMN hypoconnectivity as a behaviorally relevant neuroimaging phenotype of the sex-related spectrum of autistic traits, of which autism represents the extreme case.

Reduced Volume of the Arcuate Fasciculus in Adults with High-Functioning Autism Spectrum Conditions.

Atypical language is a fundamental feature of autism spectrum conditions (ASC), but few studies have examined the structural integrity of the arcuate fasciculus, the major white matter tract connecting frontal and temporal language regions, which is usually implicated as the main transfer route used in processing linguistic information by the brain. Abnormalities in the arcuate have been reported in young children with ASC, mostly in low-functioning or non-verbal individuals, but little is known regarding the structural properties of the arcuate in adults with ASC or, in particular, in individuals with ASC who have intact language, such as those with high-functioning autism or Asperger syndrome. We used probabilistic tractography of diffusion-weighted imaging to isolate and scrutinize the arcuate in a mixed-gender sample of 18 high-functioning adults with ASC (17 Asperger syndrome) and 14 age- and IQ-matched typically developing controls. Arcuate volume was significantly reduced bilaterally with clearest differences in the right hemisphere. This finding remained significant in an analysis of all male participants alone. Volumetric reduction in the arcuate was significantly correlated with the severity of autistic symptoms as measured by the Autism-Spectrum Quotient. These data reveal that structural differences are present even in high-functioning adults with ASC, who presented with no clinically manifest language deficits and had no reported developmental language delay. Arcuate structural integrity may be useful as an index of ASC severity and thus as a predictor and biomarker for ASC. Implications for future research are discussed.

Lost for emotion words: what motor and limbic brain activity reveals about autism and semantic theory.

Autism spectrum conditions (ASC) are characterised by deficits in understanding and expressing emotions and are frequently accompanied by alexithymia, a difficulty in understanding and expressing emotion words. Words are differentially represented in the brain according to their semantic category and these difficulties in ASC predict reduced activation to emotion-related words in limbic structures crucial for affective processing. Semantic theories view 'emotion actions' as critical for learning the semantic relationship between a word and the emotion it describes, such that emotion words typically activate the cortical motor systems involved in expressing emotion actions such as facial expressions. As ASC are also characterised by motor deficits and atypical brain structure and function in these regions, motor structures would also be expected to show reduced activation during emotion-semantic processing. Here we used event-related fMRI to compare passive processing of emotion words in comparison to abstract verbs and animal names in typically-developing controls and individuals with ASC. Relatively reduced brain activation in ASC for emotion words, but not matched control words, was found in motor areas and cingulate cortex specifically. The degree of activation evoked by emotion words in the motor system was also associated with the extent of autistic traits as revealed by the Autism Spectrum Quotient. We suggest that hypoactivation of motor and limbic regions for emotion word processing may underlie difficulties in processing emotional language in ASC. The role that sensorimotor systems and their connections might play in the affective and social-communication difficulties in ASC is discussed.

Nouns, verbs, objects, actions, and abstractions: local fMRI activity indexes semantics, not lexical categories.

Noun/verb dissociations in the literature defy interpretation due to the confound between lexical category and semantic meaning; nouns and verbs typically describe concrete objects and actions. Abstract words, pertaining to neither, are a critical test case: dissociations along lexical-grammatical lines would support models purporting lexical category as the principle governing brain organisation, whilst semantic models predict dissociation between concrete words but not abstract items. During fMRI scanning, participants read orthogonalised word categories of nouns and verbs, with or without concrete, sensorimotor meaning. Analysis of inferior frontal/insula, precentral and central areas revealed an interaction between lexical class and semantic factors with clear category differences between concrete nouns and verbs but not abstract ones. Though the brain stores the combinatorial and lexical-grammatical properties of words, our data show that topographical differences in brain activation, especially in the motor system and inferior frontal cortex, are driven by semantics and not by lexical class.

Brain routes for reading in adults with and without autism: EMEG evidence.

Reading utilises at least two neural pathways. The temporal lexical route visually maps whole words to their lexical entries, whilst the nonlexical route decodes words phonologically via parietal cortex. Readers typically employ the lexical route for familiar words, but poor comprehension plus precocity at mechanically 'sounding out' words suggests that differences might exist in autism. Combined MEG/EEG recordings of adults with autistic spectrum conditions (ASC) and controls while reading revealed preferential recruitment of temporal areas in controls and additional parietal recruitment in ASC. Furthermore, a lack of differences between semantic word categories was consistent with previous suggestion that people with ASC may lack a 'default' lexical-semantic processing mode. These results are discussed with reference to dual-route models of reading.

Motor cognition-motor semantics: action perception theory of cognition and communication.

A new perspective on cognition views cortical cell assemblies linking together knowledge about actions and perceptions not only as the vehicles of integrated action and perception processing but, furthermore, as a brain basis for a wide range of higher cortical functions, including attention, meaning and concepts, sequences, goals and intentions, and even communicative social interaction. This article explains mechanisms relevant to mechanistic action perception theory, points to concrete neuronal circuits in brains along with artificial neuronal network simulations, and summarizes recent brain imaging and other experimental data documenting the role of action perception circuits in cognition, language and communication.

Brain and behavioral correlates of action semantic deficits in autism.

Action-perception circuits containing neurons in the motor system have been proposed as the building blocks of higher cognition; accordingly, motor dysfunction should entail cognitive deficits. Autism spectrum conditions (ASC) are marked by motor impairments but the implications of such motor dysfunction for higher cognition remain unclear. We here used word reading and semantic judgment tasks to investigate action-related motor cognition and its corresponding fMRI brain activation in high-functioning adults with ASC. These participants exhibited hypoactivity of motor cortex in language processing relative to typically developing controls. Crucially, we also found a deficit in semantic processing of action-related words, which, intriguingly, significantly correlated with this underactivation of motor cortex to these items. Furthermore, the word-induced hypoactivity in the motor system also predicted the severity of ASC as expressed by the number of autistic symptoms measured by the Autism-Spectrum Quotient (Baron-Cohen etal., 2001). These significant correlations between word-induced activation of the motor system and a newly discovered semantic deficit in a condition known to be characterized by motor impairments, along with the correlation of such activation with general autistic traits, confirm critical predictions of causal theories linking cognitive and semantic deficits in ASC, in part, to dysfunctional action-perception circuits and resultant reduction of motor system activation.

Sensorimotor semantics on the spot: brain activity dissociates between conceptual categories within 150 ms.

Although semantic processing has traditionally been associated with brain responses maximal at 350-400 ms, recent studies reported that words of different semantic types elicit topographically distinct brain responses substantially earlier, at 100-200 ms. These earlier responses have, however, been achieved using insufficiently precise source localisation techniques, therefore casting doubt on reported differences in brain generators. Here, we used high-density MEG-EEG recordings in combination with individual MRI images and state-of-the-art source reconstruction techniques to compare localised early activations elicited by words from different semantic categories in different cortical areas. Reliable neurophysiological word-category dissociations emerged bilaterally at ~ 150 ms, at which point action-related words most strongly activated frontocentral motor areas and visual object-words occipitotemporal cortex. These data now show that different cortical areas are activated rapidly by words with different meanings and that aspects of their category-specific semantics is reflected by dissociating neurophysiological sources in motor and visual brain systems.