'Theory of mind' in the brain. Evidence from a PET scan study of Asperger syndrome

Faux pas detection and intentional action in Asperger Syndrome. A replication on a French sample

In the present study, we investigated mind reading abilities in a group of adults with Asperger Syndrome (AS) by using the faux pas task, an advanced test of theory of mind (Baron-Cohen et al. (1999). Journal of Autism and Developmental Disorders, 29, 407-418). The faux pas is a particular case of a non-intentional action reflecting an involuntary socially inappropriate behavior. Here, individuals with AS over-detected faux pas stories, failed to provide correct justifications of the speaker's behavior and were unaware of the mistaken belief and of the resulting emotional impact, whereas they appeared to be responsive to social rule violations. We hypothesized that because of an impaired theory-of-mind, individuals with AS may develop compensatory cognitive strategies based on overlearned abstract knowledge about normative rules.

[Social cognition in autism. A survey of functional imaging studies]

Autism spectrum disorders (autism, Asperger's syndrome, high-functioning autism) are characterized by a common pattern of marked impairments in social interactions. Deficits have been described in face processing, facial emotion recognition, and social attribution ("theory of mind") or generally speaking in social cognition. Some studies have shown that these impairments are already detectable in early childhood, leading to the assumption that the underlying cause is an early disruption of neuronal development. Accordingly, neuroimaging data have revealed alterations of structure and function in the brains of autistic children, adolescents, and adults. The present review gives a systematic overview of the existing literature on functional imaging studies using experimental paradigms of social cognition, i.e. face discrimination, facial emotion recognition, and theory of mind in autistic disorders.

Atypical frontal-posterior synchronization of Theory of Mind regions in autism during mental state attribution

This study used fMRI to investigate the functioning of the Theory of Mind (ToM) cortical network in autism during the viewing of animations that in some conditions entailed the attribution of a mental state to animated geometric figures. At the cortical level, mentalizing (attribution of metal states) is underpinned by the coordination and integration of the components of the ToM network, which include the medial frontal gyrus, the anterior paracingulate, and the right temporoparietal junction. The pivotal new finding was a functional underconnectivity (a lower degree of synchronization) in autism, especially in the connections between frontal and posterior areas during the attribution of mental states. In addition, the frontal ToM regions activated less in participants with autism relative to control participants. In the autism group, an independent psychometric assessment of ToM ability and the activation in the right temporoparietal junction were reliably correlated. The results together provide new evidence for the biological basis of atypical processing of ToM in autism, implicating the underconnectivity between frontal regions and more posterior areas.

Psychosis and autism as diametrical disorders of the social brain

Autistic-spectrum conditions and psychotic-spectrum conditions (mainly schizophrenia, bipolar disorder, and major depression) represent two major suites of disorders of human cognition, affect, and behavior that involve altered development and function of the social brain. We describe evidence that a large set of phenotypic traits exhibit diametrically opposite phenotypes in autistic-spectrum versus psychotic-spectrum conditions, with a focus on schizophrenia. This suite of traits is inter-correlated, in that autism involves a general pattern of constrained overgrowth, whereas schizophrenia involves undergrowth. These disorders also exhibit diametric patterns for traits related to social brain development, including aspects of gaze, agency, social cognition, local versus global processing, language, and behavior. Social cognition is thus underdeveloped in autistic-spectrum conditions and hyper-developed on the psychotic spectrum.;>We propose and evaluate a novel hypothesis that may help to explain these diametric phenotypes: that the development of these two sets of conditions is mediated in part by alterations of genomic imprinting. Evidence regarding the genetic, physiological, neurological, and psychological underpinnings of psychotic-spectrum conditions supports the hypothesis that the etiologies of these conditions involve biases towards increased relative effects from imprinted genes with maternal expression, which engender a general pattern of undergrowth. By contrast, autistic-spectrum conditions appear to involve increased relative bias towards effects of paternally expressed genes, which mediate overgrowth. This hypothesis provides a simple yet comprehensive theory, grounded in evolutionary biology and genetics, for understanding the causes and phenotypes of autistic-spectrum and psychotic-spectrum conditions.

Cooperation and deception recruit different subsets of the theory-of-mind network

The term "theory of mind" (ToM) describes an evolved psychological mechanism that is necessary to represent intentions and expectations in social interaction. It is thus involved in determining the proclivity of others to cooperate or defect. While in cooperative settings between two parties the intentions and expectations of the protagonists match, they diverge in deceptive scenarios, in which one protagonist is intentionally manipulated to hold a false belief about the intention of the other. In a functional magnetic resonance imaging paradigm using cartoons showing social interactions (including the outcome of the interaction) between two or three story characters, respectively, we sought to determine those brain areas of the ToM network involved in reasoning about cooperative versus deceptive interactions. Healthy volunteers were asked to reflect upon the protagonists' intentions and expectations in cartoons depicting cooperation, deception or a combination of both, where two characters cooperated to deceive a third. Reasoning about the mental states of the story characters yielded substantial differences in activation patterns: both deception and cooperation activated bilateral temporoparietal junction, parietal and cingulate regions, while deception alone additionally recruited orbitofrontal and medial prefrontal regions. These results indicate an important role for prefrontal cortex in processing a mismatch between a character's intention and another's expectations as required in complex social interactions.

The curious incident of the photo that was accused of being false: issues of domain specificity in development, autism, and brain imaging

We resume an exchange of ideas with Uta Frith that started before the turn of the century. The curious incident responsible for this exchange was the finding that children with autism fail tests of false belief, while they pass Zaitchik's (1990) photograph task (Leekam & Perner, 1991). This finding led to the conclusion that children with autism have a domain-specific impairment in Theory of Mind (mental representations), because the photograph task and the false-belief task are structurally equivalent except for the nonmental character of photographs. In this paper we argue that the false-belief task and the false-photograph task are not structurally equivalent and are not empirically associated. Instead a truly structurally equivalent task is the false-sign task. Performance on this task is strongly associated with the false-belief task. A version of this task, the misleading-signal task, also poses severe problems for children with autism (Bowler, Briskman, Gurvidi, & Fornells-Ambrojo, 2005). These new findings therefore challenge the earlier interpretation of a domain-specific difficulty in inferring mental states and suggest that children with autism also have difficulty understanding misleading nonmental objects. Brain imaging data using false-belief, "false"-photo, and false-sign scenarios provide further supporting evidence for our conclusions.

Fine cuts of empathy and the amygdala: dissociable deficits in psychopathy and autism

In the current paper, the "fine cuts" approach advocated by Uta Frith is applied to our understanding of empathy and amygdala dysfunction in two disorders, psychopathy and autism. A fine cut is made between cognitive (i.e., Theory of Mind) and emotional empathy. The literature with respect to psychopathy and autism and these two functions is then considered. A fine cut is also made between the amygdala's role in stimulus-reinforcement association and specific aspects of social cognition. Again the literature with respect to psychopathy and autism and these two functions of the amygdala is considered. It is concluded that while both conditions can be considered disorders of social cognition, fine cuts can be made dissociating the impairments associated with each.

Autism, hypersystemizing, and truth

Evidence is reviewed suggesting that, in the general population, empathizing and systemizing show strong sex differences. The function of systemizing is to predict lawful events, including lawful change, or patterns in data. Also reviewed is the evidence that individuals on the autistic spectrum have degrees of empathizing difficulties alongside hypersystemizing. The hypersystemizing theory of autism spectrum conditions (ASC) proposes that people with ASC have an unusually strong drive to systemize. This can explain their preference for systems that change in highly lawful or predictable ways; why they become disabled when faced with systems characterized by less lawful change; and their "need for sameness" or "resistance to change". If "truth" is defined as lawful patterns in data then, according to the hypersystemizing theory, people with ASC are strongly driven to discover the "truth".

Theory of mind, language and the temporoparietal junction mystery

Brain imaging of adults during false-belief story tasks consistently shows activation of the temporoparietal junction in English-speaking Americans and German-speaking Europeans. Kobayashi et al. find this observation in adult English speakers but not in English-speaking children or in English-Japanese bilingual persons. This finding suggests a cultural or linguistic influence on location of brain function and argues against maturation of innately specified neural substrates. It is reminiscent of effects of linguistic development, bilingualism and cultural differences on theory of mind development.

Switching language switches mind: linguistic effects on developmental neural bases of 'Theory of Mind'

Theory of mind (ToM)--our ability to predict behaviors of others in terms of their underlying intentions--has been examined through false-belief (FB) tasks. We studied 12 Japanese early bilingual children (8-12 years of age) and 16 late bilingual adults (18-40 years of age) with FB tasks in Japanese [first language (L1)] and English [second language (L2)], using fMRI. Children recruited more brain regions than adults for processing ToM tasks in both languages. Moreover, children showed an overlap in brain activity between the L1 and L2 ToM conditions in the medial prefrontal cortex (mPFC). Adults did not show such a convergent activity in the mPFC region, but instead, showed brain activity that varied depending on the language used in the ToM task. The developmental shift from more to less ToM specific brain activity may reflect increasing automatization of ToM processing as people age. These results also suggest that bilinguals recruit different resources to understand ToM depending on the language used in the task, and this difference is greater later in life.

Neural substrates of implicit and explicit emotional processes: a unifying framework for psychosomatic medicine

There are two broad themes in psychosomatic medicine research that relate emotions to physical disease outcomes. Theme 1 holds that self-reported negative affect has deleterious effects and self-reported positive affect has salubrious effects on health. Theme 2 holds that interference with the experience or expression of negative affect has adverse health consequences. From the perspective of self-report these two traditions appear contradictory. A key thesis of this paper is that the foundational distinction in cognitive neuroscience between explicit (conscious) and implicit (unconscious) processes, corresponding to Themes 1 and 2, respectively, provides a unifying framework that makes empirical research on unconscious emotional processes more tractable. A psychological model called "levels of emotional awareness" is presented first that places implicit and explicit emotional processes on a cognitive-developmental continuum. This model holds that the ability to become consciously aware of one's own feelings is a cognitive skill that goes through a developmental process similar to that which Piaget described for other cognitive functions. Empirical findings using the Levels of Emotional Awareness Scale are presented. A parallel hierarchical model of the neural substrates of emotional awareness is presented next supported by recent neuroimaging and lesion work. The evidence presented in this review suggests that the neural substrates of implicit and explicit emotional processes are distinct, that the latter have a modulatory effect on the former, and that at the neural level Theme 1 and Theme 2 phenomena share critical similarities. The implications of this psychobiological model for research in psychosomatic medicine are discussed.

Autism, Asperger's and other oddities ... thoughts about treatment approaches

The etiology of the Autistic Spectrum Disorders is discussed with a focus on Asperger's disorder. The manifestation of the triad of social impairment, communication impairment, and restricted repetitive behaviors and interests is discussed in terms of the various symptom phenotypes comprising these three domains. Clinical case material is used to illustrate how the treatment modality utilized should be fitted to an individual child's needs. A multimodal treatment plan is considered optimal in order to achieve a successful therapeutic outcome.

Emulation and Mimicry for Social Interaction: A Theoretical Approach to Imitation in Autism

The “broken-mirror” theory of autism argues that dysfunction of the “mirror neuron system” is a root cause of social disability in autism. The present paper aims to scrutinize this theory and, when it breaks down, to provide an alternative. Current evidence suggests that children with autism are able to understand and emulate goal-directed actions, but may have specific impairments in automatic mimicry of actions without goals. These data are not compatible with the broken-mirror theory, but can be accounted for by a new model called EP-M. The EP-M model segments the mirror neuron system into an indirect, parietal route for goal emulation and planning (EP) and a direct occipital-frontal route for mimicry (M). This fractionation is consistent with neuroimaging and behavioural studies of the mirror neuron system in typical children and adults. I suggest that top-down modulation of the direct M route may be dysfunctional in individuals with autism, leading to abnormal behaviours on mimicry tasks as well as other social disabilities.

Neural correlates of reward in autism

BACKGROUND

Lack of social interaction, which is characteristically seen in people with autistic-spectrum disorder, may be caused by malfunctioning of the frontostriatal reward systems. However, no reported in vivo brain imaging studies have investigated reward mechanisms in autistic-spectrum disorder.

AIMS

To investigate functional brain activation during reward feedback in people with autistic-spectrum disorder and control individuals.

METHOD

We used event-related functional magnetic resonance imaging to examine the neural substrates of monetary reward in individuals with autistic-spectrum disorder and matched controls.

RESULTS

When rewarded, individuals with autism compared with control individuals showed significantly greater brain activation in the left anterior cingulate gyrus. In addition, activation of this region was negatively correlated with social interaction as measured by the Autism Diagnostic Interview.

CONCLUSIONS

In people with autistic-spectrum disorder, achieving reward is associated with significant differences in the activation of areas known to be responsible for attention and arousal, and this may partially underpin some deficits in social behaviour.

Forty years on: Uta Frith's contribution to research on autism and dyslexia, 1966-2006

Uta Frith has made a major contribution to our understanding of developmental disorders, especially autism and dyslexia. She has studied the cognitive and neurobiological bases of both disorders and demonstrated distinctive impairments in social cognition and central coherence in autism, and in phonological processing in dyslexia. In this enterprise she has encouraged psychologists to work in a theoretical framework that distinguishes between observed behaviour and the underlying cognitive and neurobiological processes that mediate that behaviour.

Mouse behavioral assays relevant to the symptoms of autism

While the cause of autism remains unknown, the high concordance between monozygotic twins supports a strong genetic component. The importance of genetic factors in autism encourages the development of mutant mouse models, to advance our understanding of biological mechanisms underlying autistic behaviors. Mouse models of human neuropsychiatric diseases are designed to optimize (i) face validity (resemblance to the human symptoms) (ii) construct validity (similarity to the underlying causes of the disease) and (iii) predictive validity (expected responses to treatments that are effective in the human disease). There is a growing need for mouse behavioral tasks with all three types of validity, to define robust phenotypes in mouse models of autism. Ideal mouse models will incorporate analogies to the three diagnostic symptoms of autism: abnormal social interactions, deficits in communication and high levels of repetitive behaviors. Social approach is tested in an automated three chambered apparatus that offers the subject a choice between spending time with another mouse, with a novel object, or remaining in an empty familiar environment. Reciprocal social interaction is scored from videotapes of interactions between pairs of unfamiliar mice. Communication is evaluated by measuring emission and responses to vocalizations and olfactory cues. Repetitive behaviors are scored for measures of grooming, jumping, or stereotyped sniffing of one location or object. Insistence on sameness is modeled by scoring a change in habit, for example, reversal of the spatial location of a reinforcer in the Morris water maze or T-maze. Associated features of autism, for example, mouse phenotypes relevant to anxiety, seizures, sleep disturbances and sensory hypersensitivity, may be useful to include in a mouse model that meets some of the core diagnostic criteria. Applications of these assays include (i) behavioral phenotyping of transgenic and knockout mice with mutations in genes relevant to autism; (ii) characterization of inbred strains of mice; (iii) evaluation of environmental toxins; (iv) comparison of behavioral phenotypes with genetic factors, such as unusual expression patterns of genes or unusual single nucleotide polymorphisms; and (v) evaluation of proposed therapeutics for the treatment of autism.

A neurobehavioral examination of individuals with high-functioning autism and Asperger's disorder using a fronto-striatal model of dysfunction

The repetitive, stereotyped, and obsessive behaviors that characterize autism may in part be attributable to disruption of the region of the fronto-striatal system, which mediates executive abilities. Neuropsychological testing has shown that children with autism exhibit set-shifting deficiencies on tests such as the Wisconsin Card Sorting task but show normal inhibitory ability on variants of the Stroop color-word test. According to Minshew and Goldstein's multiple primary deficit theory, the complexity of the executive functioning task is important in determining the performance of individuals with autism. This study employed a visual-spatial task (with a Stroop-type component) to examine the integrity of executive functioning, in particular inhibition, in autism (n = 12) and Asperger's disorder (n = 12) under increasing levels of cognitive complexity. Whereas the Asperger's disorder group performed similarly to age- and IQ-matched control participants, even at the higher levels of cognitive complexity, the high-functioning autism group displayed inhibitory deficits specifically associated with increasing cognitive load.

Self-referential cognition and empathy in autism

Background

Individuals with autism spectrum conditions (ASC) have profound impairments in the interpersonal social domain, but it is unclear if individuals with ASC also have impairments in the intrapersonal self-referential domain. We aimed to evaluate across several well validated measures in both domains, whether both self-referential cognition and empathy are impaired in ASC and whether these two domains are related to each other.

Methodology/Principal Findings

Thirty adults aged 19-45, with Asperger Syndrome or high-functioning autism and 30 age, sex, and IQ matched controls participated in the self-reference effect (SRE) paradigm. In the SRE paradigm, participants judged adjectives in relation to the self, a similar close other, a dissimilar non-close other, or for linguistic content. Recognition memory was later tested. After the SRE paradigm, several other complimentary self-referential cognitive measures were taken. Alexithymia and private self-consciousness were measured via self-report. Self-focused attention was measured on the Self-Focus Sentence Completion task. Empathy was measured with 3 self-report instruments and 1 performance measure of mentalizing (Eyes test). Self-reported autistic traits were also measured with the Autism Spectrum Quotient (AQ). Although individuals with ASC showed a significant SRE in memory, this bias was decreased compared to controls. Individuals with ASC also showed reduced memory for the self and a similar close other and also had concurrent impairments on measures of alexithymia, self-focused attention, and on all 4 empathy measures. Individual differences in self-referential cognition predicted mentalizing ability and self-reported autistic traits. More alexithymia and less self memory was predictive of larger mentalizing impairments and AQ scores regardless of diagnosis. In ASC, more self-focused attention is associated with better mentalizing ability and lower AQ scores, while in controls, more self-focused attention is associated with decreased mentalizing ability and higher AQ scores. Increasing private self-consciousness also predicted better mentalizing ability, but only for individuals with ASC.

Conclusions/Significance

We conclude that individuals with ASC have broad impairments in both self-referential cognition and empathy. These two domains are also intrinsically linked and support predictions made by simulation theory. Our results also highlight a specific dysfunction in ASC within cortical midlines structures of the brain such as the medial prefrontal cortex.

Autism from developmental and neuropsychological perspectives

In this review of the research literature on autism, we argue that the application of developmental and neuropsychological perspectives has contributed importantly to the understanding of the core deficits in autism and their underlying neural bases. The three classes of theories postulated to explain the developmental and neuropsychological deficits in autism are considered in terms of the specificity, uniqueness, and universality of these impairments in autism. Because we believe that a primary reason for our lack of understanding of the developmental trajectory in autism stems from our inability to diagnose the syndrome in the first three years of life, research approaches to early identification are discussed, as are longitudinal studies aimed at identifying later-life outcomes and their predictors. In contrast to the progress made in defining the core deficits and arriving at criteria for diagnosis, less progress has been made in identifying the causes of autism and in creating and testing interventions aimed at ameliorating the impairments of autism, possibly because these activities have been less tied to the developmental and neuropsychological models that have enlightened the investigation of core deficits.

Neuropsychological frontal impairments and negative symptoms in schizophrenia

Negative symptoms have been associated with frontal lobe dysfunction in schizophrenia. However, neuropsychological studies that evaluated the correlation between performance in tests sensitive to the dorsolateral prefrontal cortex (DLPFC) and negative symptoms have shown inconsistent results. Growing evidence has appeared that not only the DLPFC but other prefrontal regions could be involved in schizophrenia. We evaluated schizophrenic patients and healthy controls using three "frontal tests": the Wisconsin Card Sorting Test (WCST), the Iowa Gambling Task (GT) and a Theory of Mind test (Faux Pas), and studied the relationship between performance in these tests and negative symptomatology. Schizophrenic patients had worse performance than normal controls on the WCST, GT and Faux Pas test. The severity of the negative symptoms showed a moderate to high correlation with performance in the Faux Pas test. Our findings support the idea that different prefrontal regions could be affected in people with schizophrenia and that the damage to each of these regions could be, at least in part, independent of the damage to the others. Some negative symptoms could be associated with frontal medial cortex dysfunction.

Dissociation Between Key Processes of Social Cognition in Autism: Impaired Mentalizing But Intact Sense of Agency

Deficits in social cognition and interaction, such as in mentalizing and imitation behavior, are hallmark features of autism spectrum disorders. Both imitation and mentalizing are at the core of the sense of agency, the awareness that we are the initiators of our own behavior. Little evidence exists regarding the sense of agency in autism. Thus, we compared high-functioning adults with autism to healthy control subjects using an action monitoring and attribution task. Subjects with autism did not show deficits in this task, yet they showed significant mentalizing deficits. Our findings indicate a dissociation between the sense of agency and ascription of mental states in autism. We propose that social-cognitive deficits in autism may arise on a higher level than that of action monitoring and awareness.

Cultural and linguistic effects on neural bases of 'Theory of Mind' in American and Japanese children

Theory of Mind (ToM) has been defined as our ability to predict behaviors of others in terms of their underlying intentions. While the developmental trajectory of ToM had been thought to be invariant across cultures, several ToM studies conducted outside the Anglo-American cultural or linguistic milieus have obtained mixed results. To examine effects of culture/language on the development of neural bases of ToM, we studied 12 American monolingual children and 12 Japanese bilingual children with second-order false-belief story and cartoon tasks, using functional magnetic resonance imaging (fMRI). While a few brain regions such as ventro-medial prefrontal cortex (vmPFC) and precuneus were recruited by both cultural/linguistic groups, several brain areas including inferior frontal gyrus (IFG) and temporo-parietal junction (TPJ) were employed in a culture/language-dependent manner during the ToM tasks. These results suggest that the neural correlates of ToM may begin to vary depending upon cultural/linguistic background from early in life.

Changes of brain activity in the neural substrates for theory of mind during childhood and adolescence

Theory of mind (ToM) refers to the ability to attribute independent mental states, such as beliefs, preferences and desires, to the self and others. Neuroimaging studies of normal adults have consistently demonstrated the importance of particular brain regions for ToM, the superior temporal sulcus (STS), temporal pole (TP) and the medial prefrontal cortex (MPFC). However, there are little data showing how ToM develops during childhood and adolescence. Such data are important for understanding the development of social functioning and its disorders. The authors used functional magnetic resonance imaging to study age-related changes in brain activity associated with ToM during childhood and early adolescence (9-16 years). Normally developed children and adolescents demonstrated significant activation in the bilateral STS, the TP adjacent to the amygdala (TP/Amy) and the MPFC. Furthermore, the authors found a positive correlation between age and the degree of activation in the dorsal part of the MPFC; in contrast, a negative correlation was found for the ventral part of the MPFC. The authors also found a positive correlation between the Z coordinate of the peak activation in the MPFC and age. The data indicated that activity in the MPFC associated with ToM shifted from the ventral to the dorsal part of the MPFC during late childhood and adolescence. No age-related changes were found in the STS and the TP/Amy regions. The authors consider that the age-related brain activity observed in the present study may be associated with the maturation of the prefrontal cortex and the associated development of cognitive functions.

Reading affect in the face and voice: neural correlates of interpreting communicative intent in children and adolescents with autism spectrum disorders

CONTEXT

Understanding a speaker's communicative intent in everyday interactions is likely to draw on cues such as facial expression and tone of voice. Prior research has shown that individuals with autism spectrum disorders (ASD) show reduced activity in brain regions that respond selectively to the face and voice. However, there is also evidence that activity in key regions can be increased if task demands allow for explicit processing of emotion.

OBJECTIVES

To examine the neural circuitry underlying impairments in interpreting communicative intentions in ASD using irony comprehension as a test case, and to determine whether explicit instructions to attend to facial expression and tone of voice will elicit more normative patterns of brain activity.

DESIGN, SETTING, AND PARTICIPANTS

Eighteen boys with ASD (aged 7-17 years, full-scale IQ >70) and 18 typically developing (TD) boys underwent functional magnetic resonance imaging at the Ahmanson-Lovelace Brain Mapping Center, University of California, Los Angeles.

MAIN OUTCOME MEASURES

Blood oxygenation level-dependent brain activity during the presentation of short scenarios involving irony. Behavioral performance (accuracy and response time) was also recorded.

RESULTS

Reduced activity in the medial prefrontal cortex and right superior temporal gyrus was observed in children with ASD relative to TD children during the perception of potentially ironic vs control scenarios. Importantly, a significant group x condition interaction in the medial prefrontal cortex showed that activity was modulated by explicit instructions to attend to facial expression and tone of voice only in the ASD group. Finally, medial prefrontal cortex activity was inversely related to symptom severity in children with ASD such that children with greater social impairment showed less activity in this region.

CONCLUSIONS

Explicit instructions to attend to facial expression and tone of voice can elicit increased activity in the medial prefrontal cortex, part of a network important for understanding the intentions of others, in children with ASD. These findings suggest a strategy for future intervention research.

When eye creates the contact! ERP evidence for early dissociation between direct and averted gaze motion processing

Direct gaze or eye contact is a strong social signal, which triggers distinct processes as compared to other gaze directions. Thus, direct gaze could be early dissociated from averted gaze during the processing of gaze direction. In order to examine the processing of gaze contact relative to averted gaze, we studied evoked potentials in human adults in response to the apparent motion of gaze. Deviated and frontal faces were presented with a fixed gaze direction, followed by an apparent movement of the eyes either toward the subject or away from him/her. The results showed that the perception of direct relative to averted gaze evoked a greater, later and longer lasting N170, suggesting that gaze contact recruited more resources than averted gaze in the early stage of gaze direction processing. Furthermore, direct and averted motion of gaze elicited distinct ERP components between 160 and 210 ms, initiated over centro-parietal electrodes. Source reconstruction revealed the involvement of the Theory-of-Mind network, including the regions of the superior temporal sulcus, the medial prefrontal and the orbitofrontal cortices, in this early dissociation. In addition, the perception of gaze contact relative to averted gaze yielded increased fronto-central P3a and parieto-occipital P3b. All the results were significant whatever the head orientation. Our findings show that gaze contact, as compared to other gaze directions, is an essential social cue which recruits early specific processes. The dissociation between direct and averted gaze processing occurs as soon as 160 ms, involving the social brain network.

fMRI investigation of working memory for faces in autism: visual coding and underconnectivity with frontal areas

Brain activation and functional connectivity were investigated in high functioning autism using functional magnetic resonance imaging in an n-back working memory task involving photographic face stimuli. The autism group showed reliably lower activation compared with controls in the inferior left prefrontal area (involved in verbal processing and working memory maintenance) and the right posterior temporal area (associated with theory of mind processing). The participants with autism also showed activation in a somewhat different location in the fusiform area than the control participants. These results suggest that the neural circuitry of the brain for face processing in autism may be analyzing the features of the face more as objects and less in terms of their human significance. The functional connectivity results revealed that the abnormal fusiform activation was embedded in a larger context of smaller and less synchronized networks, particularly indicating lower functional connectivity with frontal areas. In contrast to the underconnectivity with frontal areas, the autism group showed no underconnectivity among posterior cortical regions. These results extend previous findings of abnormal face perception in autism by demonstrating that the abnormalities are embedded in an abnormal cortical network that manages to perform the working memory task proficiently, using a visually oriented, asocial processing style that minimizes reliance on prefrontal areas.

Orienting to social stimuli differentiates social cognitive impairment in autism and schizophrenia

Both autism and schizophrenia feature deficits in aspects of social cognition that may be related to amygdala dysfunction, but it is unclear whether these are similar or different patterns of impairment. We compared the visual scanning patterns and emotion judgments of individuals with autism, individuals with schizophrenia and controls on a task well characterized with respect to amygdala functioning. On this task, eye movements of participants are recorded as they assess emotional content within a series of complex social scenes where faces are either included or digitally erased. Results indicated marked abnormalities in visual scanning for both disorders. Controls increased their gaze on face regions when faces were present to a significantly greater degree than both the autism or schizophrenia groups. While the control and the schizophrenia groups oriented to face regions faster when faces were present compared to when they were absent, the autism group oriented at the same rate in both conditions. The schizophrenia group, meanwhile, exhibited a delay in orienting to face regions across both conditions, although whether anti-psychotic medication contributed to this effect is unclear. These findings suggest that while processing emotional information in social scenes, both individuals with autism and individuals with schizophrenia fixate faces less than controls, although only those with autism fail to orient to faces more rapidly based on the presence of facial information. Autism and schizophrenia may therefore share an abnormality in utilizing facial information for assessing emotional content in social scenes, but differ in the ability to seek out socially relevant cues from complex stimuli. Impairments in social orienting are discussed within the context of evidence suggesting the role of the amygdala in orienting to emotionally meaningful information.

Cognition and medial frontal cortex in health and disease

PURPOSE OF REVIEW

Recent work on the role of the medial frontal cortex in cognition and its involvement in neurological disorders is critically reviewed.

RECENT FINDINGS

The highly influential notion of conflict monitoring by the anterior cingulate has been called into question by monkey single-cell neurophysiology and lesion studies in monkeys and humans. An alternative role for this region in adapting behaviour in response to changing demands over time is gaining support. By contrast, the more dorsally placed presupplementary motor area and supplementary eye field have been implicated in direct executive control in situations of response conflict. Although more rostral medial areas have been linked to complex cognitive operations involving references to the self, conceptual obstacles make the evidence difficult to interpret. The role of the orbitofrontal cortex in guiding action based on value has been reinforced.

SUMMARY

The role of the medial frontal cortex in cognition continues to generate both interest and controversy. A few striking discrepancies between data from functional imaging and interventional techniques illustrate the hazards of drawing strong conclusions from merely correlative evidence. More broadly, a case can be made for tempering the empirical enthusiasm here with a little more theoretical restraint.

An examination of movement kinematics in young people with high-functioning autism and Asperger's disorder: further evidence for a motor planning deficit

This paper examines upper-body movement kinematics in individuals with high-functioning autism (HFA) and Asperger's disorder (AD). In general, the results indicate that HFA is more consistently associated with impaired motoric preparation/initiation than AD. The data further suggest that this quantitative difference in motor impairment is not necessarily underpinned by greater executive dysfunction vulnerability in autism relative to AD. Quantitative motoric dissociation between autism and AD may have down-stream effects on later stages of movement resulting in qualitative differences between these disorder groups, e.g. "motor clumsiness" in AD versus "abnormal posturing" in autism. It will be important for future research to map the developmental trajectory of motor abnormalities in these disorder groups.

Social stimuli interfere with cognitive control in autism

Autism spectrum disorders are characterized by cognitive control deficits as well as impairments in social interactions. However, the brain mechanisms mediating the interactive effects of these deficits have not been addressed. We employed event-related functional magnetic resonance imaging (fMRI) to examine the effects of processing directional information from faces on activity within brain regions mediating cognitive control. High-functioning individuals with autism and age-, gender-, and IQ-matched neurotypical individuals attended to the direction of a centrally-presented arrow or gaze stimulus with similar flanker stimuli oriented in the same ("congruent") or opposite ("incongruent") direction. The incongruent arrow condition was examined to assess functioning of brain regions mediating cognitive control in a context without social-cognitive demands, whereas the incongruent gaze condition assessed functioning of the same brain regions in a social-cognitive context. Consistent with prior studies, the incongruent arrow condition recruited activity in bilateral midfrontal gyrus, right inferior frontal gyrus, bilateral intraparietal sulcus, and the anterior cingulate relative to the congruent arrow condition in neurotypical participants. Notably, there were not diagnostic group differences in patterns of regional fMRI activation in response to the arrow condition. However, while viewing the incongruent gaze stimuli, although neurotypical participants recruited the same brain regions, participants with autism showed marked hypoactivation in these areas. These findings suggest that processing social-cognitive stimuli interferes with functioning of brain regions recruited during cognitive control tasks in autism. Implications for research into cognitive control deficits in autism are discussed.

Children's and adults' neural bases of verbal and nonverbal 'theory of mind'

Theory of mind (ToM) - our ability to predict behaviors of others in terms of their underlying intentions - has been examined through verbal and nonverbal false-belief (FB) tasks. Previous brain imaging studies of ToM in adults have implicated medial prefrontal cortex (mPFC) and temporo-parietal junction (TPJ) for adults' ToM ability. To examine age and modality related differences and similarities in neural correlates of ToM, we tested 16 adults (18-40 years old) and 12 children (8-12 years old) with verbal (story) and nonverbal (cartoon) FB tasks, using functional magnetic resonance imaging (fMRI). Both age groups showed significant activity in the TPJ bilaterally and right inferior parietal lobule (IPL) in a modality-independent manner, indicating that these areas are important for ToM during both adulthood and childhood, regardless of modality. We also found significant age-related differences in the ToM condition-specific activity for the story and cartoon tasks in the left inferior frontal gyrus (IFG) and left TPJ. These results suggest that depending on the modality adults may utilize different brain regions from children in understanding ToM.

The study of autism as a distributed disorder

Past autism research has often been dedicated to tracing the causes of the disorder to a localized neurological abnormality, a single functional network, or a single cognitive-behavioral domain. In this review, I argue that autism is a "distributed disorder" on various levels of study (genetic, neuroanatomical, neurofunctional, behavioral). "Localizing" models are therefore not promising. The large array of potential genetic risk factors suggests that multiple (or all) emerging functional brain networks are affected during early development. This is supported by widespread growth abnormalities throughout the brain. Interactions during development between affected functional networks and atypical experiential effects (associated with atypical behavior) in children with autism further complicate the neurological bases of the disorder, resulting in an "exponentially distributed" profile. Promising approaches to a better characterization of neural endophenotypes in autism are provided by techniques investigating white matter and connectivity, such as MR spectroscopy, diffusion-tensor imaging (DTI), and functional connectivity MRI. According to a recent hypothesis, the autistic brain is generally characterized by "underconnectivity." However, not all findings are consistent with this view. The concepts and methodology of functional connectivity need to be refined and results need to be corroborated by anatomical studies (such as DTI tractography) before definitive conclusions can be drawn.

Personhood and neuroscience: naturalizing or nihilating?

Personhood is a foundational concept in ethics, yet defining criteria have been elusive. In this article we summarize attempts to define personhood in psychological and neurological terms and conclude that none manage to be both specific and non-arbitrary. We propose that this is because the concept does not correspond to any real category of objects in the world. Rather, it is the product of an evolved brain system that develops innately and projects itself automatically and irrepressibly onto the world whenever triggered by stimulus features such as a human-like face, body, or contingent patterns of behavior. We review the evidence for the existence of an autonomous person network in the brain and discuss its implications for the field of ethics and for the implicit morality of everyday behavior.

Eyes always attract attention but gaze orienting is task-dependent: Evidence from eye movement monitoring

Eyes and gaze are central to social cognition but whether they attract attention differently depending on the task is unknown. Here, the shift in attention towards the eye region and gaze direction of a perceived face was studied in two tasks by monitoring eye movements. The same face stimuli in front- or 3/4-view, with direct or averted gaze, were used in both tasks. In the Gaze task, subjects performed an explicit gaze direction judgment (gaze straight or averted) while in the Head task they performed a head orientation judgment (front- or 3/4-view). Gaze processing was evident in both tasks as shown by longer RTs and lower accuracy when head and gaze directions did not match. In both tasks the eye region was the most attended area but the amount of viewing was task-dependent. Most importantly, approximately 90% of the initial saccades landed in the eye region in the Gaze task but only approximately 50% of them did so in the Head task. These saccades were made in the direction signaled by gaze in the Gaze task but in the direction signaled by head orientation in the Head task. Altogether, these task-modulated behaviors argue against a purely exogenous and automatic orienting-to-gaze mechanism. Based on patient work and neuroimaging studies of gaze processing, we suggest that this task-dependent orienting behavior is rather endogenous and subtended by cortical areas amongst which frontal regions play a central role. We discuss the implications of this finding for clinical populations.

Social-cognition and the broad autism phenotype: identifying genetically meaningful phenotypes

BACKGROUND

Strong evidence from twin and family studies suggests that the genetic liability to autism may be expressed through personality and language characteristics qualitatively similar, but more subtly expressed than those defining the full syndrome. This study examined behavioral features of this 'broad autism phenotype' (BAP) in relation to performance on a measure of social-cognition in an attempt to tease out this complex clinical picture and identify markers of underlying neuropsychological systems of genetic significance to autism. We hypothesized that mild social-cognitive impairment would be associated with clinically defined social characteristics of the BAP (aloof personality style, lower quality social relationships, and impaired pragmatic language use).

METHOD

Forty-eight parents of individuals with autism (13 of whom were identified as 'aloof'), and 22 control parents, were administered the 'Eyes Test', a social-cognitive measure that taps the ability to read complex psychological states from viewing only the eye region of faces.

RESULTS

Whereas social-cognitive ability was unimpaired among parents of autistic children in general, the subgroup of parents defined as 'aloof' displayed significant social-cognitive deficits on the 'Eyes Test'. Impaired social-cognitive ability was associated with low quality of friendships and problems with pragmatic language use, associations which mirror those documented in autism.

CONCLUSIONS

Findings suggest that social-cognitive impairments co-segregate with conceptually related personality, social, and language features that constitute the BAP, and point towards performance on the Eyes Test as a genetically meaningful endophenotype.

Frontal anatomy and reaction time in Autism

Widespread frontal lobe abnormalities, encompassing anatomy and function, are known to be implicated in Autistic Spectrum Disorders (ASD). The correlation between neurobiology and behaviour, however, is poorly understood in ASD. The aim of this study was to investigate frontal lobe anatomy and cognitive function in individuals with ASD, compared to control subjects. Thus, we assessed whole brain and frontal lobe parenchymal volume, and grey and white matter density differences in ASD, compared to control subjects, using high resolution T1-weighted magnetic resonance imaging (MRI). Furthermore, all subjects underwent a computerized reaction time task (RTT) for cognitive assessment. No differences in total parenchymal brain volume were observed, however, autistic individuals showed significantly smaller frontal lobe parenchymal volume (FLPV) and decreased white matter density, compared to control subjects. Error rates did not differ significantly between groups during the RTT, but ASD individuals responded significantly slower to target stimuli. Furthermore, reduced FLPV correlated positively with increased reaction time in individual with ASD. Decreased FLPV could be an indicator for abnormal brain development resulting in reduced processing speed in ASD.

Systemizing empathy: teaching adults with Asperger syndrome or high-functioning autism to recognize complex emotions using interactive multimedia

This study evaluated Mind Reading, an interactive systematic guide to emotions, for its effectiveness in teaching adults with Asperger syndrome (AS) and high-functioning autism (HFA) to recognize complex emotions in faces and voices. Experiment 1 tested a group of adults diagnosed with AS/HFA (n = 19) who used the software at home for 10-15 weeks. Participants were tested on recognition of faces and voices at three different levels of generalization. A matched control group of adults with AS/HFA (n = 22) were assessed without any intervention. In addition, a third group of general population controls (n = 24) was tested. Experiment 2 repeated the design of Experiment 1 with a group of adults with AS/HFA who used the software at home and met in a group with a tutor on a weekly basis. They were matched to a control group of adults with AS/HFA attending social skills training and to a general population control group (n = 13 for all three groups). In both experiments the intervention group improved significantly more than the control group on close, but not distant, generalization tasks. Verbal IQ had significant effects in Experiment 2. Using Mind Reading for a relatively short period of time allows users to learn to recognize a variety of complex emotions and mental states. However, additional methods are required to enhance generalization.

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.

Meanings in motion and faces: developmental associations between the processing of intention from geometrical animations and gaze detection accuracy

Aspects of face processing, on the one hand, and theory of mind (ToM) tasks, on the other hand, show specific impairment in autism. We aimed to discover whether a correlation between tasks tapping these abilities was evident in typically developing children at two developmental stages. One hundred fifty-four normal children (6-8 years and 16-18 years) and 13 high-IQ autistic children (11-17 years) were tested on a range of face-processing and IQ tasks, and a ToM test based on the attribution of intentional movement to abstract shapes in a cartoon. By midchildhood, the ability accurately and spontaneously to infer the locus of attention of a face with direct or averted gaze was specifically associated with the ability to describe geometrical animations using mental state terms. Other face-processing and animation descriptions failed to show the association. Autistic adolescents were impaired at both gaze processing and ToM descriptions, using these tests. Mentalizing and gaze perception accuracy are associated in typically developing children and adolescents. The findings are congruent with the possibility that common neural circuitry underlies, at least in part, processing implicated in these tasks. They are also congruent with the possibility that autism may lie at one end of a developmental continuum with respect to these skills, and to the factor(s) underpinning them.

Decreased prefrontal activation during letter fluency task in adults with pervasive developmental disorders: A near-infrared spectroscopy study

Functional neuroimaging studies have suggested that dysfunction of prefrontal cortex (PFC) is present in persons with pervasive developmental disorders (PDD). Recently, the development of near-infrared spectroscopy (NIRS) has enabled noninvasive bedside measurement of regional cerebral blood volume. Although NIRS enables the noninvasive clarification of brain functions in many psychiatric disorders, it has not yet been used to examine subjects with PDD. The aim of our study was to conduct an NIRS cognitive activation study to verify PFC dysfunction in PDD. The subjects were 10 adults with PDD and 10 age- and gender-matched healthy subjects. Hemoglobin concentration changes were measured with a 24-channel NIRS machine during the letter fluency task. While the number of words generated during the letter fluency task did not differ significantly between groups, the analysis of covariance including IQ as a confounding covariate showed that the PDD group was associated with bilateral reduction in oxy-hemoglobin concentration change as compared with the control group. The statistical results did not change when only IQ-matched high-functioning subjects (N=7) were included. Moreover, reduced oxy-hemoglobin concentration change for the right PFC was significantly correlated with verbal communication deficits within the PDD group. The present findings are consistent with proposed prefrontal dysfunction in PDD subjects identified by other neuroimaging modalities. The present results may be also potentially useful for applying NIRS to clinical settings of child psychiatry.

Cultural and linguistic influence on neural bases of 'Theory of Mind': an fMRI study with Japanese bilinguals

Theory of mind (ToM)-our ability to predict behaviors of others in terms of their underlying intentions-has been thought to be universal and invariant across different cultures. However, several ToM studies conducted outside the Anglo-American cultural or linguistic boundaries have obtained mixed results. To examine the influence of culture/language on neural bases of ToM, we studied 16 American English-speaking monolinguals and 16 Japanese-English bilinguals with second-order false-belief story tasks, using functional magnetic resonance imaging (fMRI). Several neural correlates of ToM including medial prefrontal cortex (mPFC) and anterior cingulate cortex (ACC) were recruited by both cultural/linguistic groups. However, some other brain areas including inferior frontal gyrus (IFG) were employed in a culture/language-specific manner, during the ToM tasks. These results suggest that the ways in which adults understand ToM are not entirely universal.

The Perception of Animacy in Young Children with Autism

Visual perception may be a developmental prerequisite to some types of social understanding. The ability to perceive social information given visual motion appears to develop early. However, children with autism have profound deficits in social cognitive function and may fail to see social motion in the same way that typically developing children do. We tested the hypothesis that children with autism fail to discriminate animate motion, using a novel paradigm involving simple geometric figures. The subjects were 23 children with autism (c.a. 70.7 mos.), 18 children with other developmental disabilities (c.a. 68.2 mos.), and 18 typically developing children (c.a. 46.4 mos.). Children saw two circles moving on a screen and were rewarded for identifying the one that moved as if animate. A control condition required children to identify the heavier of two objects. Children with autism initially showed a deficit in categorizing objects as animate (though no deficit on the control task), but showed no deficit in this ability after they had reached criterion in the training phase. These results are discussed in terms of the social orienting theory of autism, and the possibility that animacy perception might be preserved in autism, even if it is not used automatically.

The hyper-systemizing, assortative mating theory of autism

The hyper-systemizing theory of autism proposes that the systemizing mechanism is set too high in people with autism. As a result, they can only cope with highly lawful systems, and cannot cope with systems of high variance or change (such as the social world of other minds). They appear 'change-resistant'. This proposal extends the extreme male brain theory of autism. Finally, evidence is reviewed for autism being the genetic result of assortative mating of two high systemizers.

A visual joke fMRI investigation into Theory of Mind and enhanced risk of schizophrenia

Theory of Mind (ToM) or mentalizing is the ability of individuals to determine the intentions and behavior of others. This ability is known to be compromised in schizophrenia and has been shown to fluctuate with symptom severity. Neuropsychological investigations into relatives of individuals with schizophrenia have shown that some relatives also show a deficit in this area of social cognition. In order to address this state and trait issue, we investigated the performance of high-risk relatives of individuals with schizophrenia to those of a matched control group (n = 13) on a blocked design visual joke fMRI paradigm. The task involved looking at two sets of cartoon jokes, one set which required mentalizing abilities to understand the jokes and another set that did not require such abilities. Relatives were divided into two groups based on the presence (HR+, n = 12) or absence (HR-, n = 12) of positive symptoms. The task provided robust activations across the groups in areas previously associated with mentalizing abilities, such as the PFC, precuneus, and temporal lobes. Significant between-group activations were observed in the PFC (primarily BA6, 8, and 9) with the HR- activating significantly greater than the HR+ in these regions. Both a secondary state-specific analysis and a third post hoc analysis further investigating state effects showed significant PFC between-group differences. This study is the first time relatives of individuals with schizophrenia have been imaged using a ToM paradigm, and the results provide evidence of both a state and state-mediated trait effect.

Differential activation of the amygdala and the 'social brain' during fearful face-processing in Asperger Syndrome

Impaired social cognition is a core feature of autism. There is much evidence showing people with autism use a different cognitive style than controls for face-processing. We tested if people with autism would show differential activation of social brain areas during a face-processing task. Thirteen adults with high-functioning autism or Asperger Syndrome (HFA/AS) and 13 matched controls. We used fMRI to investigate 'social brain' activity during perception of fearful faces. We employed stimuli known to reliably activate the amygdala and other social brain areas, and ROI analyses to investigate brain areas responding to facial threat as well as those showing a linear response to varying threat intensities. We predicted: (1) the HFA/AS group would show differential activation (as opposed to merely deficits) of the social brain compared to controls and (2) that social brain areas would respond to varied intensity of fear in the control group, but not the HFA/AS group. Both predictions were confirmed. The controls showed greater activation in the left amygdala and left orbito-frontal cortex, while the HFA/AS group showed greater activation in the anterior cingulate gyrus and superior temporal cortex. The control group also showed varying responses in social brain areas to varying intensities of fearful expression, including differential activations in the left and right amygdala. This response in the social brain was absent in the HFA/AS group. HFA/AS are associated with different patterns of activation of social brain areas during fearful emotion processing, and the absence in the HFA/AS brain of a response to varying emotional intensity.

Impaired self-awareness and theory of mind: an fMRI study of mentalizing in alexithymia

Alexithymic individuals have difficulty in recognizing and describing emotions in themselves. We investigated the neuronal basis of mentalizing in alexithymia to determine whether there is a common neuronal substrate associated with knowing the mental states of the self and others. Individuals high in alexithymia (n = 16) and low in alexithymia (n = 14) were selected from a pool of 310 college students using a combination of the Toronto Alexithymia Scale (TAS-20) and the Structured Interview version of the Beth Israel Questionnaire (SIBIQ). We compared the two groups on psychological measures, including ratings of mentalizing and the Interpersonal Reactivity Index (IRI), and regional brain activation using functional magnetic resonance imaging (fMRI) during a mentalizing animation task. The results for both groups showed activation in regions associated with mentalizing: medial prefrontal cortices (MPFC), temporo-parietal junctions (TPJ), and the temporal pole (TP). Alexithymics had lower mentalizing and IRI perspective-taking scores and less activation in the right MPFC. Activity in the MPFC was positively correlated with the mentalizing score and the IRI perspective-taking score. Although there were no group differences in cerebral activity in the TPJ and the TP, the activity in the right TP had a positive correlation with mentalizing and IRI personal distress scores. These results suggest that alexithymic individuals have an impairment in mentalizing associated with an inability to take the perspective of others. Thus, the skills involved in comprehending the self and others are inter-related and play an important role in emotion regulation.