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

Social intelligence in the normal and autistic brain: an fMRI study

There is increasing support for the existence of 'social intelligence' [Humphrey (1984) Consciousness Regained], independent of general intelligence. Brothers et al. 1990) J. Cog. Neurosci., 4, 107-118] proposed a network of neural regions that comprise the 'social brain': the orbito-frontal cortex (OFC), superior temporal gyrus (STG) and amygdala. We tested Brothers' theory by examining both normal subjects as well as patients with high-functioning autism or Asperger syndrome (AS), who are well known to have deficits in social intelligence, and perhaps deficits in amygdala function [Bauman & Kemper (1988) J. Neuropath. Exp. Neurol., 47, 369]. We used a test of judging from the expressions of another person's eyes what that other person might be thinking or feeling. Using functional magnetic resonance imaging (fMRI) we confirmed Brothers' prediction that the STG and amygdala show increased activation when using social intelligence. Some areas of the prefrontal cortex also showed activation. In contrast, patients with autism or AS activated the fronto-temporal regions but not the amygdala when making mentalistic inferences from the eyes. These results provide support for the social brain theory of normal function, and the amygdala theory of autism.

Brain mapping of language and auditory perception in high-functioning autistic adults: a PET study

We examined the brain organization for language and auditory functions in five high-functioning autistic and five normal adults, using [15O]-water positron emission tomography (PET). Cerebral blood flow was studied for rest, listening to tones, and listening to, repeating, and generating sentences. The autism group (compared to the control group) showed (a) reversed hemispheric dominance during verbal auditory stimulation; (b) a trend towards reduced activation of auditory cortex during acoustic stimulation; and (c) reduced cerebellar activation during nonverbal auditory perception and possibly expressive language. These results are compatible with findings of cerebellar anomalies and may suggest a tendency towards atypical dominance for language in autism.

Acquired 'theory of mind' impairments following stroke

The ability to attribute thoughts and feelings to self and others ('theory of mind') has been hypothesised to have an innate neural basis and a dedicated cognitive mechanism. Evidence in favour of this proposal has come from autism; a brain-based developmental disorder which appears to be characterised by impaired theory of mind, despite sometimes good general reasoning skills/IQ. To date no case of specific acquired theory of mind impairment has been reported. The present study examined theory of mind in adults who had suffered right hemisphere stroke, a group known to show pragmatic and social difficulties. In one study using story materials and two using cartoons, patients' understanding of materials requiring attribution of mental states (e.g. ignorance, false belief) was significantly worse than their understanding of non-mental control materials. Data from healthy elderly subjects, and a small group of left hemisphere patients (who received the tasks in modified form), suggest that this impairment on mental state tasks is not a function of task difficulty. The findings support the notion of a dedicated cognitive system for theory of mind, and suggest a role for the healthy right hemisphere in the attribution of mental states.

Brain regions involved in the perception of gaze: a PET study

Mutual gaze may be described as a psychological process during which two persons have the feeling of a brief link between their two minds. In the monkey, specific cell assemblies in the superior temporal cortex of the brain are responsive to gaze. This suggests that the brain may have evolved mechanisms for interpreting direct eye contact. These mechanisms could depend on the activation of specific brain regions. Positron emission tomography was used to measure activity in brain regions in healthy volunteers while they were looking at faces featuring, respectively, eye contact, averted gaze, or no gaze. As expected a region known to be involved in face processing was found to be activated in the ventral occipito-temporal region, especially in the right hemisphere. Averted gaze and mutual gaze triggered blood flow responses in similar areas which were different from those involved in face processing. These areas included the occipital part of the fusiform gyrus, the right parietal lobule, the right inferior temporal gyrus, and the middle temporal gyrus in both hemispheres. These results are consistent with the hypothesis that perception of eyes regardless of the direction of the gaze is subserved by a distributed network. However, no conclusive evidence was found for specific area(s) devoted to mutual gaze processing.

Neuropsychiatric disorders

Neuropsychiatric disorders of childhood include autism spectrum disorders, disorders comprising attention deficits (attention-deficit-hyperactivity disorder and deficits in attention, motor control and perception), tics (motor or vocal, or both), and obsessions and compulsions (obsessive-compulsive disorder). They affect a small proportion of the child population. They can now reliably be diagnosed, and are valid and clinically meaningful conditions. Effective interventions are available for most of these disorders.

Asperger syndrome and high-functioning autism

This paper reviews the history of Asperger syndrome (AS) and high-functioning autism (HFA), current diagnostic concepts and criteria, some controversial diagnostic issues, epidemiology, background factors, outcome, and intervention guidelines.

The biological basis of autism

Stimulated by recent advances in genetics and neurobiology, there has been a rapid expansion of studies aimed at elucidating the biological basis of autism. Molecular genetic studies looking for susceptibility genes in this disorder are currently being conducted, and neuroimaging studies attempting to identify characteristic structural and functional brain abnormalities are under way. The results of these studies are likely to have a significant impact on our understanding of the pathogenesis of autism.