Developmental deficits in social perception in autism: the role of the amygdala and fusiform face area

Common and distinct neural features of social and non-social reward processing in autism and social anxiety disorder

Autism spectrum disorders (ASDs) and social anxiety disorder (SAD) are both characterized by social dysfunction, but no study to date has compared neural responses to social rewards in ASDs and SAD. Neural responses during social and non-social reward anticipation and outcomes were examined in individuals with ASD (n = 16), SAD (n = 15) and a control group (n = 19) via functional magnetic resonance imaging. Analyses modeling all three groups revealed increased nucleus accumbens (NAc) activation in SAD relative to ASD during monetary reward anticipation, whereas both the SAD and ASD group demonstrated decreased bilateral NAc activation relative to the control group during social reward anticipation. During reward outcomes, the SAD group did not differ significantly from the other two groups in ventromedial prefrontal cortex activation to either reward type. Analyses comparing only the ASD and SAD groups revealed greater bilateral amygdala activation to social rewards in SAD relative to ASD during both anticipation and outcome phases, and the magnitude of left amygdala hyperactivation in the SAD group during social reward anticipation was significantly correlated with the severity of trait anxiety symptoms. Results suggest reward network dysfunction to both monetary and social rewards in SAD and ASD during reward anticipation and outcomes, but that NAc hypoactivation during monetary reward anticipation differentiates ASD from SAD.

Animal model of autism induced by prenatal exposure to valproate: altered glutamate metabolism in the hippocampus

Autism spectrum disorders (ASD) are characterized by deficits in social interaction, language and communication impairments and repetitive and stereotyped behaviors, with involvement of several areas of the central nervous system (CNS), including hippocampus. Although neurons have been the target of most studies reported in the literature, recently, considerable attention has been centered upon the functionality and plasticity of glial cells, particularly astrocytes. These cells participate in normal brain development and also in neuropathological processes. The present work investigated hippocampi from 15 (P15) and 120 (P120) days old male rats prenatally exposed to valproic acid (VPA) as an animal model of autism. Herein, we analyzed astrocytic parameters such as glutamate transporters and glutamate uptake, glutamine synthetase (GS) activity and glutathione (GSH) content. In the VPA group glutamate uptake was unchanged at P15 and increased 160% at P120; the protein expression of GLAST did not change neither in P15 nor in P120, while GLT1 decreased 40% at P15 and increased 92% at P120; GS activity increased 43% at P15 and decreased 28% at P120; GSH content was unaltered at P15 and had a 27% increase at P120. These data highlight that the astrocytic clearance and destination of glutamate in the synaptic cleft might be altered in autism, pointing out important aspects to be considered from both pathophysiologic and pharmacological approaches in ASD.

The Interplay between Emotion and Cognition in Autism Spectrum Disorder: Implications for Developmental Theory

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that is clinically defined by abnormalities in reciprocal social and communicative behaviors and an inflexible adherence to routinised patterns of thought and behavior. Laboratory studies repeatedly demonstrate that autistic individuals experience difficulties in recognizing and understanding the emotional expressions of others and naturalistic observations show that they use such expressions infrequently and inappropriately to regulate social exchanges. Dominant theories attribute this facet of the ASD phenotype to abnormalities in a social brain network that mediates social-motivational and social-cognitive processes such as face processing, mental state understanding, and empathy. Such theories imply that only emotion related processes relevant to social cognition are compromised in ASD but accumulating evidence suggests that the disorder may be characterized by more widespread anomalies in the domain of emotions. In this review I summarize the relevant literature and argue that the social-emotional characteristics of ASD may be better understood in terms of a disruption in the domain-general interplay between emotion and cognition. More specifically I will suggest that ASD is the developmental consequence of early emerging anomalies in how emotional responses to the environment modulate a wide range of cognitive processes including those that are relevant to navigating the social world.

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

BACKGROUND

Although impaired social-emotional ability is a hallmark of autism spectrum disorder (ASD), the perceptual skills and mediating strategies contributing to the social deficits of autism are not well understood. A perceptual skill that is fundamental to effective social communication is the ability to accurately perceive and interpret facial emotions. To evaluate the expression processing of participants with ASD, we designed the Let's Face It! Emotion Skills Battery (LFI! Battery), a computer-based assessment composed of three subscales measuring verbal and perceptual skills implicated in the recognition of facial emotions.

METHODS

We administered the LFI! Battery to groups of participants with ASD and typically developing control (TDC) participants that were matched for age and IQ.

RESULTS

On the Name Game labeling task, participants with ASD (N = 68) performed on par with TDC individuals (N = 66) in their ability to name the facial emotions of happy, sad, disgust and surprise and were only impaired in their ability to identify the angry expression. On the Matchmaker Expression task that measures the recognition of facial emotions across different facial identities, the ASD participants (N = 66) performed reliably worse than TDC participants (N = 67) on the emotions of happy, sad, disgust, frighten and angry. In the Parts-Wholes test of perceptual strategies of expression, the TDC participants (N = 67) displayed more holistic encoding for the eyes than the mouths in expressive faces whereas ASD participants (N = 66) exhibited the reverse pattern of holistic recognition for the mouth and analytic recognition of the eyes.

CONCLUSION

In summary, findings from the LFI! Battery show that participants with ASD were able to label the basic facial emotions (with the exception of angry expression) on par with age- and IQ-matched TDC participants. However, participants with ASD were impaired in their ability to generalize facial emotions across different identities and showed a tendency to recognize the mouth feature holistically and the eyes as isolated parts.

Teaching emotion recognition skills to young children with autism: a randomised controlled trial of an emotion training programme

BACKGROUND

Children with autism have difficulties in emotion recognition and a number of interventions have been designed to target these problems. However, few emotion training interventions have been trialled with young children with autism and co-morbid ID. This study aimed to evaluate the efficacy of an emotion training programme for a group of young children with autism with a range of intellectual ability.

METHODS

Participants were 55 children with autistic disorder, aged 4-7 years (FSIQ 42-107). Children were randomly assigned to an intervention (n = 28) or control group (n = 27). Participants in the intervention group watched a DVD designed to teach emotion recognition skills to children with autism (the Transporters), whereas the control group watched a DVD of Thomas the Tank Engine. Participants were assessed on their ability to complete basic emotion recognition tasks, mindreading and theory of mind (TOM) tasks before and after the 4-week intervention period, and at 3-month follow-up.

RESULTS

Analyses controlled for the effect of chronological age, verbal intelligence, gender and DVD viewing time on outcomes. Children in the intervention group showed improved performance in the recognition of anger compared with the control group, with few improvements maintained at 3-month follow-up. There was no generalisation of skills to TOM or social skills.

CONCLUSIONS

The Transporters programme showed limited efficacy in teaching basic emotion recognition skills to young children with autism with a lower range of cognitive ability. Improvements were limited to the recognition of expressions of anger, with poor maintenance of these skills at follow-up. These findings provide limited support for the efficacy of the Transporters programme for young children with autism of a lower cognitive range.

Relating anatomical and social connectivity: white matter microstructure predicts emotional empathy

Understanding cues to the internal states of others involves a widely distributed network of brain regions. Although white matter (WM) connections are likely crucial for communication between these regions, the role of anatomical connectivity in empathic processing remains unexplored. The present study tested for a relationship between anatomical connectivity and empathy by assessing the WM microstructural correlates of affective empathy, which promotes interpersonal understanding through emotional reactions, and cognitive empathy, which does so via perspective taking. Associations between fractional anisotropy (FA) and the emotional (empathic concern, EC) and cognitive (perspective taking, PT) dimensions of empathy as assessed by the Interpersonal Reactivity Index were examined. EC was positively associated with FA in tracts providing communicative pathways within the limbic system, between perception and action-related regions, and between perception and affect-related regions, independently of individual differences in age, gender, and other dimensions of interpersonal reactivity. These findings provide a neuroanatomical basis for the rapid, privileged processing of emotional sensory information and the automatic elicitation of responses to the affective displays of others.

Autism spectrum disorder: does neuroimaging support the DSM-5 proposal for a symptom dyad? A systematic review of functional magnetic resonance imaging and diffusion tensor imaging studies

A systematic review of 208 studies comprising functional magnetic resonance imaging and diffusion tensor imaging data in patients with 'autism spectrum disorder' (ASD) was conducted, in order to determine whether these data support the forthcoming DSM-5 proposal of a social communication and behavioral symptom dyad. Studies consistently reported abnormal function and structure of fronto-temporal and limbic networks with social and pragmatic language deficits, of temporo-parieto-occipital networks with syntactic-semantic language deficits, and of fronto-striato-cerebellar networks with repetitive behaviors and restricted interests in ASD patients. Therefore, this review partially supports the DSM-5 proposal for the ASD dyad.

Brief report: Selective social anhedonia in high functioning autism

Diminished social motivation is one of the most striking features in autism. Yet, few studies have directly assessed the value people with an ASD place on social interactions, or how rewarding they report it to be. In the present study, we directly measure social motivation by looking at responses to a questionnaire assessing self-reported pleasure in social and non social situations. Twenty-nine adolescents with ASD and matched controls took part in the study. Our results reveal that children with an ASD differ from the controls with respect to social enjoyment, but not with respect to physical and other sources of hedonism. Further analyses demonstrate that the degree of social anhedonia correlates with autism severity.

Cognition in males and females with autism: similarities and differences

The male bias in autism spectrum conditions (ASC) has led to females with ASC being under-researched. This lack of attention to females could hide variability due to sex that may explain some of the heterogeneity within ASC. In this study we investigate four key cognitive domains (mentalizing and emotion perception, executive function, perceptual attention to detail, and motor function) in ASC, to test for similarities and differences between males and females with and without ASC (n = 128 adults; n = 32 per group). In the mentalizing and facial emotion perception domain, males and females with ASC showed similar deficits compared to neurotypical controls. However, in attention to detail and dexterity involving executive function, although males with ASC showed poorer performance relative to neurotypical males, females with ASC performed comparably to neurotypical females. We conclude that performance in the social-cognitive domain is equally impaired in male and female adults with ASC. However, in specific non-social cognitive domains, performance within ASC depends on sex. This suggests that in specific domains, cognitive profiles in ASC are modulated by sex.

Valence scaling of dynamic facial expressions is altered in high-functioning subjects with autism spectrum disorders: an fMRI study

FMRI was performed with the dynamic facial expressions fear and happiness. This was done to detect differences in valence processing between 25 subjects with autism spectrum disorders (ASDs) and 27 typically developing controls. Valence scaling was abnormal in ASDs. Positive valence induces lower deactivation and abnormally strong activity in ASD in multiple regions. Negative valence increased deactivation in visual areas in subjects with ASDs. The most marked differences between valences focus on fronto-insular and temporal regions. This supports the idea that subjects with ASDs may have difficulty in passive processing of the salience and mirroring of expressions. When the valence scaling of brain activity fails, in contrast to controls, these areas activate and/or deactivate inappropriately during facial stimuli presented dynamically.

Social perception in autism spectrum disorders: impaired category selectivity for dynamic but not static images in ventral temporal cortex

Studies of autism spectrum disorders (ASDs) reveal dysfunction in the neural systems mediating object processing (particularly faces) and social cognition, but few investigations have systematically assessed the specificity of the dysfunction. We compared cortical responses in typically developing adolescents and those with ASD to stimuli from distinct conceptual domains known to elicit category-related activity in separate neural systems. In Experiment 1, subjects made category decisions to photographs, videos, and point-light displays of people and tools. In Experiment 2, subjects interpreted displays of simple, geometric shapes in motion depicting social or mechanical interactions. In both experiments, we found a selective deficit in the ASD subjects for dynamic social stimuli (videos and point-light displays of people, moving geometric shapes), but not static images, in the functionally localized lateral region of the right fusiform gyrus, including the fusiform face area. In contrast, no group differences were found in response to either static images or dynamic stimuli in other brain regions associated with face and social processing (e.g. posterior superior temporal sulcus, amygdala), suggesting disordered connectivity between these regions and the fusiform gyrus in ASD. This possibility was confirmed by functional connectivity analysis.

The role of the amygdala in atypical gaze on emotional faces in autism spectrum disorders

Reduced focus toward the eyes is a characteristic of atypical gaze on emotional faces in autism spectrum disorders (ASD). Along with the atypical gaze, aberrant amygdala activity during face processing compared with neurotypically developed (NT) participants has been repeatedly reported in ASD. It remains unclear whether the previously reported dysfunctional amygdalar response patterns in ASD support an active avoidance of direct eye contact or rather a lack of social attention. Using a recently introduced emotion classification task, we investigated eye movements and changes in blood oxygen level-dependent (BOLD) signal in the amygdala with a 3T MRI scanner in 16 autistic and 17 control adult human participants. By modulating the initial fixation position on faces, we investigated changes triggered by the eyes compared with the mouth. Between-group interaction effects revealed different patterns of gaze and amygdalar BOLD changes in ASD and NT: Individuals with ASD gazed more often away from than toward the eyes, compared with the NT group, which showed the reversed tendency. An interaction contrast of group and initial fixation position further yielded a significant cluster of amygdala activity. Extracted parameter estimates showed greater response to eyes fixation in ASD, whereas the NT group showed an increase for mouth fixation. The differing patterns of amygdala activity in combination with differing patterns of gaze behavior between groups triggered by direct eye contact and mouth fixation, suggest a dysfunctional profile of the amygdala in ASD involving an interplay of both eye-avoidance processing and reduced orientation.

Neural mechanisms of encoding social and non-social context information in autism spectrum disorder

Individuals with autism spectrum disorder (ASD) often fail to attach context to their memories and are specifically impaired in processing social aspects of contextual information. The aim of the present study was to investigate the modulatory influence of social vs. non-social context on neural mechanisms during encoding in ASD. Using event-related fMRI, 13 boys with ASD and 13 typically developing boys comparable for age and IQ were investigated during encoding of neutral objects presented either with a social (faces) or a non-social (houses) context. A memory paradigm was then applied to identify brain activation patterns associated with encoding of subsequently recollected versus non-recollected objects. On the behavioural level, no significant between-group differences emerged. In particular, no differential effects of context on memory performance were observed. Neurally, however, context-specific group differences were observed in several brain regions. During encoding of subsequently recollected objects presented with a face, ASD subjects (compared to controls) showed reduced neural activation in the bilateral inferior frontal gyrus, bilateral middle frontal gyrus and right inferior parietal lobule. Neural activation in the right inferior frontal gyrus was positively correlated with memory performance in controls, but negatively in ASD individuals. During encoding of subsequently non-recollected objects presented in the non-social context, ASD subjects showed increased activation in the dorsal MPFC. Our findings suggest that in ASD subjects, fronto-parietal brain regions subserving memory formation and the association of contextual information are activated atypically when a social context is presented at encoding. The data add to findings from related research fields indicating that in ASD, socioemotional impairment extends into domains beyond social cognition. Increased activation in the dorsal MPFC in ASD individuals might reflect supervisory cognitive processes related to the suppression of a distracting non-social context.

Development of home cage social behaviors in BALB/cJ vs. C57BL/6J mice

BALB/cJ and C57BL/6J inbred mouse strains have been proposed as useful models of low and high levels of sociability (tendency to seek social interaction), respectively, based primarily on behaviors of ∼30-day-old mice in the Social Approach Test (SAT). In the SAT, approach and sniffing behaviors of a test mouse toward an unfamiliar stimulus mouse are measured in a novel environment. However, it is unclear whether such results generalize to a familiar environment with a familiar social partner, such as with a littermate in a home cage environment. We hypothesized that C57BL/6J mice would show higher levels of social behaviors than BALB/cJ mice in the home cage environment, particularly at 30 days-of-age. We measured active and passive social behaviors in home cages by pairs of BALB/cJ or C57BL/6J littermates at ages 30, 41, and 69 days. The strains did not differ robustly in their active social behaviors. C57BL/6J mice were more passively social than BALB/cJ mice at 30 days, and C57BL/6J levels of passive social behaviors declined to BALB/cJ levels by 69 days. The differences in passive social behaviors at 30 days-of-age were primarily attributable to differences in huddling. These results indicate that different test conditions (SAT conditions vs. home cage conditions) elicit strain differences in distinct types of behaviors (approach/sniffing vs. huddling behaviors, respectively). Assessment of the more naturalistic social interactions in the familiar home cage environment with a familiar littermate will provide a useful component of a comprehensive assessment of social behaviors in mouse models relevant to autism.

1H-MRS in autism spectrum disorders: a systematic meta-analysis

We conducted a systematic review and meta-analysis of proton magnetic resonance spectroscopy (1H-MRS) studies comparing autism spectrum disorder (ASD) patients with healthy controls, with the aim of profiling ASD-associated changes in the metabolites N-acetyl-aspartate (NAA) and Creatine (Cr). Meta-regression models of NAA and Cr levels were employed, using data from 20 eligible studies (N = 852), to investigate age-dependent differences in both global brain and region-specific metabolite levels, while controlling for measurement method (Cr-ratio versus absolute concentrations). Decreased NAA concentrations that were specific to children were found for whole-brain grey and white matter. In addition, a significant decrease in NAA was evident across age categories in the parietal cortex, the cerebellum, and the anterior cingulate cortex. Higher levels of Cr were observed for ASD adults than children in global grey matter, with specific increases for adults in the temporal lobe and decreased Cr in the occipital lobe in children. No differences were found for either NAA or Cr in the frontal lobes. These data provide some evidence that ASD is characterized by age-dependent fluctuations in metabolite levels across the whole brain and at the level of specific regions thought to underlie ASD-associated behavioural and affective deficits. Differences in Cr as a function of age and brain region suggests caution in the interpretation of Cr-based ratio measures of metabolites. Despite efforts to control for sources of heterogeneity, considerable variability in metabolite levels was observed in frontal and temporal regions, warranting further investigation.

Temporal discounting of monetary rewards in children and adolescents with ADHD and autism spectrum disorders

It has been difficult to differentiate attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in terms of some aspects of their cognitive profile. While both show deficits in executive functions, it has been suggested that they may differ in their response to monetary reward. For instance, children with ADHD prefer small immediate over large delayed rewards more than typically developing controls. One explanation for this is that they discount the value of rewards to a higher degree as they are moved into the future. The current study investigated whether children with ADHD can be differentiated from those with ASD in terms of reward discounting. Thirty-nine children (8-16 y) with ADHD, 34 children with ASD and 46 typically developing controls performed a hypothetical monetary temporal discounting task. Participants were instructed to make repeated choices between small variable rewards (0, 5, 10, 20, 30€) delivered immediately and large rewards delivered after a variable delay. Children with ADHD but not ASD discounted future rewards at a higher rate than typically developing controls. These data confirm steeper discounting of future rewards in ADHD and add to a small but growing literature showing that the psychological profile of ADHD can be distinguished from that of ASD in terms of disrupted motivational processes.

Alexithymia and the processing of emotional facial expressions (EFEs): systematic review, unanswered questions and further perspectives

Alexithymia is characterized by difficulties in identifying, differentiating and describing feelings. A high prevalence of alexithymia has often been observed in clinical disorders characterized by low social functioning. This review aims to assess the association between alexithymia and the ability to decode emotional facial expressions (EFEs) within clinical and healthy populations. More precisely, this review has four main objectives: (1) to assess if alexithymia is a better predictor of the ability to decode EFEs than the diagnosis of clinical disorder; (2) to assess the influence of comorbid factors (depression and anxiety disorder) on the ability to decode EFE; (3) to investigate if deficits in decoding EFEs are specific to some levels of processing or task types; (4) to investigate if the deficits are specific to particular EFEs. Twenty four studies (behavioural and neuroimaging) were identified through a computerized literature search of Psycinfo, PubMed, and Web of Science databases from 1990 to 2010. Data on methodology, clinical characteristics, and possible confounds were analyzed. The review revealed that: (1) alexithymia is associated with deficits in labelling EFEs among clinical disorders, (2) the level of depression and anxiety partially account for the decoding deficits, (3) alexithymia is associated with reduced perceptual abilities, and is likely to be associated with impaired semantic representations of emotional concepts, and (4) alexithymia is associated with neither specific EFEs nor a specific valence. These studies are discussed with respect to processes involved in the recognition of EFEs. Future directions for research on emotion perception are also discussed.

Emotional face processing in neurotypicals with autistic traits: implications for the broad autism phenotype

The present study investigated emotional face processing in neurotypicals selected for autistic traits (AT). Participants (N=81), who obtained scores one standard deviation above or below average on the Autism Spectrum Quotient, were tested using observational fear conditioning (FC), a face version of the attention probe task, and the "Reading the Mind in the Eyes" test. The results indicated that high AT participants displayed enhanced observational FC, no attentional bias to fearful faces, and increased latency (but normal accuracy) to recognizing the mental state of another. To a certain extent, this pattern resembles the social-emotional phenotype that was previously described in autism spectrum disorders. Therefore, these results may contribute to the broad autism phenotype perspective.

Do the eyes have it? Extraction of identity and positive expression from another's eyes in autism, probed using "Bubbles"

BACKGROUND

It has been debated whether attending to a particular facial region, such as the eyes, is impaired in children with autism. The purpose of this study was to verify the poor eye gaze hypothesis postulating that children with High-Functioning Autism (HFA)/AS are impaired in their ability to attend to another's eyes.

METHODS

Our study used the "Bubbles" method. A group with ASD (n=15) and a paired non-ASD group (n=18) completed an identity judgment task requiring a binary judgment of the identity of a person in an image, and an emotion judgment task requiring perception of expressed happiness in a facial image.

RESULTS

Results indicated that similar to non-ASD individuals, ASD individuals used information from other people's eyes to judge identity as well as emotion, and performed as successfully as the non-ASD group both in identity and emotion judgment tasks. The results challenge the conventional hypothesis that individuals with ASD cannot attend to or derive information from another's eyes.

CONCLUSION

Our findings combined with the results of poor eye gaze to expressions of fear in previous studies suggest that ASD individuals can derive information pertaining to positive emotion, but cannot sufficiently extract information pertaining to negative emotion from another's eyes.

Affective responses by adults with autism are reduced to social images but elevated to images related to circumscribed interests

Individuals with autism spectrum disorders (ASD) demonstrate increased visual attention and elevated brain reward circuitry responses to images related to circumscribed interests (CI), suggesting that a heightened affective response to CI may underlie their disproportionate salience and reward value in ASD. To determine if individuals with ASD differ from typically developing (TD) adults in their subjective emotional experience of CI object images, non-CI object images and social images, 213 TD adults and 56 adults with ASD provided arousal ratings (sensation of being energized varying along a dimension from calm to excited) and valence ratings (emotionality varying along dimension of approach to withdrawal) for a series of 114 images derived from previous research on CI. The groups did not differ on arousal ratings for any image type, but ASD adults provided higher valence ratings than TD adults for CI-related images, and lower valence ratings for social images. Even after co-varying the effects of sex, the ASD group, but not the TD group, gave higher valence ratings to CI images than social images. These findings provide additional evidence that ASD is characterized by a preference for certain categories of non-social objects and a reduced preference for social stimuli, and support the dissemination of this image set for examining aspects of the circumscribed interest phenotype in ASD.

Reward processing in autism: a thematic series

This thematic series presents theoretical and empirical papers focused on understanding autism from the perspective of reward processing deficits. Although the core symptoms of autism have not traditionally been conceptualized with respect to altered reward-based processes, it is clear that brain reward circuitry plays a critical role in guiding social and nonsocial learning and behavior throughout development. Additionally, brain reward circuitry may respond to social sources of information in ways that are similar to responses to primary rewards, and recent clinical data consistently suggest abnormal behavioral and neurobiologic responses to rewards in autism. This thematic series presents empirical data and review papers that highlight the utility of considering autism from the perspective of reward processing deficits. Our hope is that this novel framework may further elucidate autism pathophysiology, with the ultimate goal of yielding novel insights with potential therapeutic implications.

Changes in grey matter development in autism spectrum disorder

Results on grey matter (GM) structural alterations in autism spectrum disorder (ASD) are inconclusive. Moreover, little is known about age effects on brain-structure abnormalities in ASD beyond childhood. Here, we aimed to examine regional GM volumes in a large sample of children, adolescents, and adults with ASD. Magnetic resonance imaging scans were obtained in 47 male ASD subjects and 51 matched healthy controls aged 8-50 years. We used whole-brain voxel-based morphometry to first assess group differences in regional GM volume across age. Moreover, taking a cross-sectional approach, group differences in age effects on regional GM volume were investigated. Compared to controls, ASD subjects showed reduced GM volumes in the anterior cingulate cortex, posterior superior temporal sulcus, and middle temporal gyrus. Investigation of group differences in age effects on regional GM volume revealed complex, region-specific alterations in ASD. While GM volumes in the amygdala, temporoparietal junction, septal nucleus and middle cingulate cortex increased in a negative quadratic fashion in both groups, data indicated that GM volume curves in ASD subjects were shifted to the left along the age axis. Moreover, while GM volume in the right precentral gyrus decreased linearly with age in ASD individuals, GM volume development in controls followed a U-shaped pattern. Based on a large sample, our voxel-based morphometry results on group differences in regional GM volumes help to resolve inconclusive findings from previous studies in ASD. Results on age-related changes of regional GM volumes suggest that ASD is characterized by complex alterations in lifetime trajectories of several brain regions that underpin social-cognitive and motor functions.

Reward circuitry dysfunction in psychiatric and neurodevelopmental disorders and genetic syndromes: animal models and clinical findings

This review summarizes evidence of dysregulated reward circuitry function in a range of neurodevelopmental and psychiatric disorders and genetic syndromes. First, the contribution of identifying a core mechanistic process across disparate disorders to disease classification is discussed, followed by a review of the neurobiology of reward circuitry. We next consider preclinical animal models and clinical evidence of reward-pathway dysfunction in a range of disorders, including psychiatric disorders (i.e., substance-use disorders, affective disorders, eating disorders, and obsessive compulsive disorders), neurodevelopmental disorders (i.e., schizophrenia, attention-deficit/hyperactivity disorder, autism spectrum disorders, Tourette's syndrome, conduct disorder/oppositional defiant disorder), and genetic syndromes (i.e., Fragile X syndrome, Prader-Willi syndrome, Williams syndrome, Angelman syndrome, and Rett syndrome). We also provide brief overviews of effective psychopharmacologic agents that have an effect on the dopamine system in these disorders. This review concludes with methodological considerations for future research designed to more clearly probe reward-circuitry dysfunction, with the ultimate goal of improved intervention strategies.

Passive and motivated perception of emotional faces: qualitative and quantitative changes in the face processing network

Emotionally expressive faces are processed by a distributed network of interacting sub-cortical and cortical brain regions. The components of this network have been identified and described in large part by the stimulus properties to which they are sensitive, but as face processing research matures interest has broadened to also probe dynamic interactions between these regions and top-down influences such as task demand and context. While some research has tested the robustness of affective face processing by restricting available attentional resources, it is not known whether face network processing can be augmented by increased motivation to attend to affective face stimuli. Short videos of people expressing emotions were presented to healthy participants during functional magnetic resonance imaging. Motivation to attend to the videos was manipulated by providing an incentive for improved recall performance. During the motivated condition, there was greater coherence among nodes of the face processing network, more widespread correlation between signal intensity and performance, and selective signal increases in a task-relevant subset of face processing regions, including the posterior superior temporal sulcus and right amygdala. In addition, an unexpected task-related laterality effect was seen in the amygdala. These findings provide strong evidence that motivation augments co-activity among nodes of the face processing network and the impact of neural activity on performance. These within-subject effects highlight the necessity to consider motivation when interpreting neural function in special populations, and to further explore the effect of task demands on face processing in healthy brains.

Social 'wanting' dysfunction in autism: neurobiological underpinnings and treatment implications

Most behavioral training regimens in autism spectrum disorders (ASD) rely on reward-based reinforcement strategies. Although proven to significantly increase both cognitive and social outcomes and successfully reduce aberrant behaviors, this approach fails to benefit a substantial number of affected individuals. Given the enormous amount of clinical and financial resources devoted to behavioral interventions, there is a surprisingly large gap in our knowledge of the basic reward mechanisms of learning in ASD. Understanding the mechanisms for reward responsiveness and reinforcement-based learning is urgently needed to better inform modifications that might improve current treatments. The fundamental goal of this review is to present a fine-grained literature analysis of reward function in ASD with reference to a validated neurobiological model of reward: the 'wanting'/'liking' framework. Despite some inconsistencies within the available literature, the evaluation across three converging sets of neurobiological data (neuroimaging, electrophysiological recordings, and neurochemical measures) reveals good evidence for disrupted reward-seeking tendencies in ASD, particularly in social contexts. This is most likely caused by dysfunction of the dopaminergic-oxytocinergic 'wanting' circuitry, including the ventral striatum, amygdala, and ventromedial prefrontal cortex. Such a conclusion is consistent with predictions derived from diagnostic criteria concerning the core social phenotype of ASD, which emphasize difficulties with spontaneous self-initiated seeking of social encounters (that is, social motivation). Existing studies suggest that social 'wanting' tendencies vary considerably between individuals with ASD, and that the degree of social motivation is both malleable and predictive of intervention response. Although the topic of reward responsiveness in ASD is very new, with much research still needed, the current data clearly point towards problems with incentive-based motivation and learning, with clear and important implications for treatment. Given the reliance of behavioral interventions on reinforcement-based learning principles, we believe that a systematic focus on the integrity of the reward system in ASD promises to yield many important clues, both to the underlying mechanisms causing ASD and to enhancing the efficacy of existing and new interventions.

Young children with autism spectrum disorder do not preferentially attend to biological motion

Preferential attention to biological motion can be seen in typically developing infants in the first few days of life and is thought to be an important precursor in the development of social communication. We examined whether children with autism spectrum disorder (ASD) aged 3-7 years preferentially attend to point-light displays depicting biological motion. We found that children with ASD did not preferentially attend to biological motion over phase-scrambled motion, but did preferentially attend to a point-light display of a spinning top rather than a human walker. In contrast a neurotypical matched control group preferentially attended to the human, biological motion in both conditions. The results suggest a core deficit in attending to biological motion in ASD.

Joint attention, social-cognition, and recognition memory in adults

The early emerging capacity for Joint Attention (JA), or socially coordinated visual attention, is thought to be integral to the development of social-cognition in childhood. Recent studies have also begun to suggest that JA affects adult cognition as well, but methodological limitations hamper research on this topic. To address this issue we developed a novel virtual reality paradigm that integrates eye-tracking and virtual avatar technology to measure two types of JA in adults, Initiating Joint Attention (IJA) and Responding to Joint Attention (RJA). Distinguishing these types of JA in research is important because they are thought to reflect unique, as well as common constellations of processes involved in human social-cognition and social learning. We tested the validity of the differentiation of IJA and RJA in our paradigm in two studies of picture recognition memory in undergraduate students. Study 1 indicated that young adults correctly identified more pictures they had previously viewed in an IJA condition (67%) than in a RJA (58%) condition, η² = 0.57. Study 2 controlled for IJA and RJA stimulus viewing time differences, and replicated the findings of Study 1. The implications of these results for the validity of the paradigm and research on the affects of JA on adult social-cognition are discussed.

ERP responses differentiate inverted but not upright face processing in adults with ASD

Individuals with autism spectrum disorders (ASD) have documented deficits in face processing, face memory and abnormal activation of the neural circuitry that supports these functions. To examine speed of processing of faces in ASD, high density event-related brain potentials were recorded to images of faces, inverted faces and non-face objects from 32 high-functioning adults with ASD and controls. Participants were instructed to focus on a cross hair prior to stimulus onset; the cross-hair location directed the participant's eye gaze to the eye region at stimulus onset. Although the ASD group preformed more poorly on behavioral tests of face and object memory, both groups demonstrated similar ERP responses, characterized by greater (positive) P1 and (negative) N170 amplitude to faces vs houses. N170 speed of processing to faces did not differ between groups. However, only the control group demonstrated differential responses to upright vs inverted faces. For the ASD group, the differential response to inverted vs upright faces was associated with better performance on face memory and self-reported social skills. It is possible that the use of attention cues may facilitate face processing in high-functioning adults with ASD, suggesting that the underlying neural circuitry can be activated in adults with ASD under specific demands.

The implications of social neuroscience for social disability

Social disability represents a unifying feature in the diverse group of individuals with autism spectrum disorder (ASD). Social neuroscience is the study of brain mechanisms supporting interpersonal interaction. In this paper, we review brain imaging studies of the social brain and highlight practical applications of these scientific insights. Understanding of social brain mechanisms holds promise as a tool for defining meaningful subgroups of children with ASD to facilitate genetic analyses and to inform treatment selection. Because social brain systems emerge in infancy, social neuroscience may help to detect atypical development before symptoms manifest. This conceptualization of ASD is a hopeful one, as social brain systems remain malleable well into development and are thus amenable to targeted intervention.

INDUCED EEG GAMMA OSCILLATION ALIGNMENT IMPROVES DIFFERENTIATION BETWEEN AUTISM AND ADHD GROUP RESPONSES IN A FACIAL CATEGORIZATION TASK

INTRODUCTION: Children diagnosed with an autism spectrum disorder (ASD) often lack the ability to recognize and properly respond to emotional stimuli. Emotional deficits also characterize children with attention deficit/hyperactivity disorder (ADHD), in addition to exhibiting limited attention span. These abnormalities may effect a difference in the induced EEG gamma wave burst (35-45 Hz) peaked approximately 300-400 milliseconds following an emotional stimulus. Because induced gamma oscillations are not fixed at a definite point in time post-stimulus, analysis of averaged EEG data with traditional methods may result in an attenuated gamma burst power. METHODS: We used a data alignment technique to improve the averaged data, making it a better representation of the individual induced EEG gamma oscillations. A study was designed to test the response of a subject to emotional stimuli, presented in the form of emotional facial expression images. In a four part experiment, the subjects were instructed to identify gender in the first two blocks of the test, followed by differentiating between basic emotions in the final two blocks (i.e. anger vs. disgust). EEG data was collected from ASD (n=10), ADHD (n=9), and control (n=11) subjects via a 128 channel EGI system, and processed through a continuous wavelet transform and bandpass filter to isolate the gamma frequencies. A custom MATLAB code was used to align the data from individual trials between 200-600 ms post-stimulus, EEG site, and condition by maximizing the Pearson product-moment correlation coefficient between trials. The gamma power for the 400 ms window of maximum induced gamma burst was then calculated and compared between subject groups. RESULTS AND CONCLUSION: Condition (anger/disgust recognition, gender recognition) × Alignment × Group (ADHD, ASD, Controls) interaction was significant at most of parietal topographies (e.g., P3-P4, P7-P8). These interactions were better manifested in the aligned data set. Our results show that alignment of the induced gamma oscillations improves sensitivity of this measure in differentiation of EEG responses to emotional facial stimuli in ADHD and ASD.

Effects of a common variant in the CD38 gene on social processing in an oxytocin challenge study: possible links to autism

The intranasal application of oxytocin (OT) has been shown to influence behavioral and neural correlates of social processing. These effects are probably mediated by genetic variations within the OT system. One potential candidate could be the CD38 gene, which codes for a transmembrane protein engaged in OT secretion processes. A common variation in this gene (rs3796863) was recently found to be associated with autism spectrum disorders (ASD). Using an imaging genetics approach, we studied differential effects of an intranasal OT application on neural processing of social stimuli in 55 healthy young men depending on their CD38 gene variant in a double-blind placebo-controlled crossover design. Genotype had a significant influence on both behavioral and neuronal measures of social processing. Homozygotic risk allele carriers showed slower reaction times (RT) and higher activation of left fusiform gyrus during visual processing of social stimuli. Under OT activation differences between genotypes were more evident (though not statistically significantly increased) and RT were accelerated in homozygotic risk allele carriers. According to our data, rs3796863 mainly influences fusiform gyrus activation, an area which has been widely discussed in ASD research. OT seems to modulate this effect by enhancing activation differences between allele groups, which suggests an interaction between genetic makeup and OT availability on fusiform gyrus activation. These results support recent approaches to apply OT as a pharmacological treatment of ASD symptoms.

Age Trends in Visual Exploration of Social and Nonsocial Information in Children with Autism

Because previous studies of attention in autism spectrum disorders (ASD) have been restricted in age range examined, little is known about how these processes develop over the course of childhood. In this study we examined cross-sectional age effects on patterns of visual attention to social and nonsocial information in 43 typically developing children and 51 children with ASD ranging in age from 2 to 18. Results indicated a sharp increase in visual exploration with age and a decrease in perseverative and detail-focused attention for both groups of children. However, increased age was associated with greater increases in visual exploration for typically developing children than for those children with ASD. The developmental differences were most pronounced for attention to certain nonsocial stimuli as children with ASD demonstrated a disproportionate attentional bias for these stimuli from very early in life. Disproportionate visual attention to certain nonsocial objects relative to social stimuli in ASD spanned from early to late childhood, and thus may represent both an early and a persistent characteristic of the disorder.

The social motivation theory of autism

The idea that social motivation deficits play a central role in Autism Spectrum Disorders (ASD) has recently gained increased interest. This constitutes a shift in autism research, which has traditionally focused more intensely on cognitive impairments, such as theory-of-mind deficits or executive dysfunction, and has granted comparatively less attention to motivational factors. This review delineates the concept of social motivation and capitalizes on recent findings in several research areas to provide an integrated account of social motivation at the behavioral, biological and evolutionary levels. We conclude that ASD can be construed as an extreme case of diminished social motivation and, as such, provides a powerful model to understand humans' intrinsic drive to seek acceptance and avoid rejection.

Processing of novel and familiar faces in infants at average and high risk for autism

The study investigated whether infant siblings of children with autism (sibs-ASD) process familiar and novel faces differently from typical infants and whether sensitivity to face familiarity is associated with infants' social and communicative behaviors. Visual event-related potentials (ERPs) were recorded in 35 infants, age 9 months ± 15 days (20 typical infants, 15 sibs-ASD) using an oddball paradigm presenting photographs of infants' mothers (70% of trials) and an unfamiliar female (30% of trials). Eye tracking responses to a different unfamiliar face were recorded to determine whether differences in gaze patterns might account for any ERP differences found. There were no group differences in the distribution, number or duration of fixations. Both infant groups differentiated between mothers and strangers, as reflected in amplitude modulations of posterior N290/P400 and frontal/central Nc responses. Group differences were present in the latency of the P400 response, where a delayed response to the stranger face was observed only in typical infants. Across both groups, shorter Nc latency to mother's face was associated with parental reports of stronger interpersonal skills. Individual differences in the speed of processing for novel vs. familiar faces may be an informative early marker of risk for atypical social development.

Autism as a neural systems disorder: a theory of frontal-posterior underconnectivity

The underconnectivity theory of autism attributes the disorder to lower anatomical and functional systems connectivity between frontal and more posterior cortical processing. Here we review evidence for the theory and present a computational model of an executive functioning task (Tower of London) implementing the assumptions of underconnectivity. We make two modifications to a previous computational account of performance and brain activity in typical individuals in the Tower of London task (Newman et al., 2003): (1) the communication bandwidth between frontal and parietal areas was decreased and (2) the posterior centers were endowed with more executive capability (i.e., more autonomy, an adaptation is proposed to arise in response to the lowered frontal-posterior bandwidth). The autism model succeeds in matching the lower frontal-posterior functional connectivity (lower synchronization of activation) seen in fMRI data, as well as providing insight into behavioral response time results. The theory provides a unified account of how a neural dysfunction can produce a neural systems disorder and a psychological disorder with the widespread and diverse symptoms of autism.

Longitudinal in-vivo diffusion tensor imaging for assessing brain developmental changes in BALB/cJ mice, a model of reduced sociability relevant to autism

Diffusion tensor imaging (DTI) is highly sensitive in detecting brain structure and connectivity phenotypes in autism spectrum disorders (ASD). Since one of the core symptoms of ASD is reduced sociability (reduced tendency to seek social interaction), we hypothesized that DTI will be sensitive in detecting neural phenotypes that correlate with decreased sociability in mouse models. Relative to C57BL/6J (B6) mice, juvenile BALB/cJ mice show reduced sociability. We performed social approach test in a three-chambered apparatus and in-vivo longitudinal DTI at post-natal days 30, 50 and 70 days-of-age in BALB/cJ (n=32) and B6 (n=15) mice to assess the correlation between DTI and sociability and to evaluate differences in DTI parameters between these two strains. Fractional anisotropy (FA) and mean diffusivity (MD) values from in-vivo DTI data were analyzed from white matter (corpus callosum, internal and external capsule) and gray matter (cerebral cortex, frontal motor cortex, hippocampus, thalamus and amygdaloid) regions based on their relevance to ASD. A moderate but significant (p<0.05) negative correlation between sociability and FA in hippocampus and frontal motor cortex was noted for BALB/cJ mice at 30 days-of-age. Significant differences in FA and MD values between BALB/cJ and B6 mice were observed in most white and gray matter areas at all three time points. Significant differences in developmental trajectories of FA and MD values from thalamus and frontal motor cortex were also observed between BALB/cJ and B6, indicating relative under-connectivity in BALB/cJ mice. These results indicate that DTI may be used as an in-vivo, non-invasive imaging method to assess developmental trajectories of brain connectivity in mouse models of neurodevelopmental and behavioral disorders.

Reward system dysfunction in autism spectrum disorders

Although it has been suggested that social deficits of autism spectrum disorders (ASDs) are related to reward circuitry dysfunction, very little is known about the neural reward mechanisms in ASD. In the current functional magnetic resonance imaging study, we investigated brain activations in response to both social and monetary reward in a group of children with ASD, relative to matched controls. Participants with ASD showed the expected hypoactivation in the mesocorticolimbic circuitry in response to both reward types. In particular, diminished activation in the nucleus accumbens was observed when money, but not when social reward, was at stake, whereas the amygdala and anterior cingulate cortex were hypoactivated within the ASD group in response to both rewards. These data indicate that the reward circuitry is compromised in ASD in social as well as in non-social, i.e. monetary conditions, which likely contributes to atypical motivated behaviour. Taken together, with incentives used in this study sample, there is evidence for a general reward dysfunction in ASD. However, more ecologically valid social reward paradigms are needed to fully understand, whether there is any domain specificity to the reward deficit that appears evident in ASD, which would be most consistent with the ASD social phenotype.

Coloured filters enhance the visual perception of social cues in children with autism spectrum disorders

Coloured filters have been found to reduce visual distortion of text in children with autism spectrum disorders (ASD). We investigated the effect of the overlays on the "mind in the eye" task in children with ASD and controls matched for age, gender, and nonverbal IQ. Children were shown photographs of the periocular region of various faces and were asked to judge which emotion was being expressed in the eyes. In children with ASD, the perception of the emotion was significantly improved when the photograph was covered by a coloured overlay. The improvement was significantly greater than in the controls, who showed no significant effect of the overlay. A perceptual impairment may contribute to the social difficulties shown in ASD.

Parsing heterogeneity in autism spectrum disorders: visual scanning of dynamic social scenes in school-aged children

OBJECTIVE

To examine patterns of variability in social visual engagement and their relationship to standardized measures of social disability in a heterogeneous sample of school-aged children with autism spectrum disorders (ASD).

METHOD

Eye-tracking measures of visual fixation during free-viewing of dynamic social scenes were obtained for 109 children with ASD (mean age, 10.2 ± 3.2 years), 37 of whom were matched with 26 typically-developing (TD) children (mean age, 9.5 ± 2.2 years) on gender, age, and IQ. The smaller subset allowed between-group comparisons, whereas the larger group was used for within-group examinations of ASD heterogeneity.

RESULTS

Between-group comparisons revealed significantly attenuated orientation to socially salient aspects of the scenes, with the largest effect size (Cohen's d = 1.5) obtained for reduced fixation on faces. Within-group analyses revealed a robust association between higher fixation on the inanimate environment and greater social disability. However, the associations between fixation on the eyes and mouth and social adaptation varied greatly, even reversing, when comparing different cognitive profile subgroups.

CONCLUSIONS

Although patterns of social visual engagement with naturalistic social stimuli are profoundly altered in children with ASD, the social adaptivity of these behaviors varies for different groups of children. This variation likely represents different patterns of adaptation and maladaptation that should be traced longitudinally to the first years of life, before complex interactions between early predispositions and compensatory learning take place. We propose that variability in these early mechanisms of socialization may serve as proximal behavioral manifestations of genetic vulnerabilities.

A critical review of the development of face recognition: experience is less important than previously believed

Historically, it has been argued that face individuation develops very slowly, not reaching adult levels until adolescence, with experience being the driving force behind this protracted improvement. Here, we challenge this view based on extensive review of behavioural and neural findings. Results demonstrate qualitative presence of all key phenomena related to face individuation (encoding of novel faces, holistic processing effects, face-space effects, face-selective responses in neuroimaging) at the earliest ages tested, typically 3-5 years of age and in many cases even infancy. Results further argue for quantitative maturity by early childhood, based on an increasing number of behavioural studies that have avoided the common methodological problem of restriction of range, as well as event-related potential (ERP), but not functional magnetic resonance imaging (fMRI) studies. We raise a new possibility that could account for the discrepant fMRI findings-namely, the use of adult-sized head coils on child-sized heads. We review genetic and innate contributions to face individuation (twin studies, neonates, visually deprived monkeys, critical periods, perceptual narrowing). We conclude that the role of experience in the development of the mechanisms of face identification has been overestimated. The emerging picture is that the mechanisms supporting face individuation are mature early, consistent with the social needs of children for reliable person identification in everyday life, and are also driven to an important extent by our evolutionary history.

Atypical brain responses to reward cues in autism as revealed by event-related potentials

Social motivation deficit theories suggest that children with autism do not properly anticipate and appreciate the pleasure of social stimuli. In this study, we investigated event-related brain potentials evoked by cues that triggered social versus monetary reward anticipation in children with autism. Children with autism showed attenuated P3 activity in response to cues associated with a timely reaction to obtain a reward, irrespective of reward type. We attribute this atypical P3 activity in response to reward cues as reflective of diminished motivated attention to reward signals, a possible contributor to reduced social motivation in autism. Thus, our findings suggest a general reward processing deficit rather than a specific social reward dysfunction in autism.

Multi-channel near-infrared spectroscopy shows reduced activation in the prefrontal cortex during facial expression processing in pervasive developmental disorder

AIM

The purpose of the present study was to investigate whether individuals with pervasive developmental disorders (PDD) show differential activation during an emotional activation task compared with age- and sex-matched controls, by measuring changes in the concentration of oxygenated (oxyHb) and deoxygenated (deoxyHb) hemoglobin, using near-infrared spectroscopy (NIRS).

METHODS

Fourteen patients with PDD and 14 age- and sex-matched healthy controls participated in the study. The relative changes of concentrations of oxyHb and deoxyHb were measured on NIRS during an implicit processing task of fearful expression using Japanese standard faces.

RESULTS

PDD patients had significantly reduced oxyHb changes in the prefrontal cortex (PFC) compared to healthy controls.

CONCLUSION

PFC dysfunction may exist in PDD.

Diminished social motivation negatively impacts reputation management: autism spectrum disorders as a case in point

Human beings are endowed with a unique motivation to be included in social interactions. This natural social motivation, in turn, is thought to encourage behaviours such as flattery or self-deprecation aimed to ease interaction and to enhance the reputation of the individual who produces them. If this is the case, diminished social interest should affect reputation management. Here, we use Autism Spectrum Disorders (ASDs)--primarily characterised by pervasive social disinterest--as a model to investigate the effect of social motivation on reputation management. Children first rated a set of pictures and were then given the opportunity to inflate their initial ratings in front of an experimenter who declared that she had drawn the picture. Contrary to the controls, children with ASD did not enhance their ratings in the drawer's presence. Moreover, participants' flattery behaviour correlated with self-reports of social enjoyment. Our findings point to a link between diminished social interest and reputation management.

Functional magnetic resonance imaging of facial information processing in children with autistic disorder, attention deficit hyperactivity disorder and typically developing controls

The present study used functional magnetic resonance imaging (fMRI) to compare the neural activation patterns of children diagnosed with autistic disorder (AD), attention deficit hyperactivity disorder (ADHD), and typically developing controls (TCs) in response to a task involving evaluation of facial expressions. Substantially greater functional activity was noted in TCs compared to both subjects diagnosed with AD and ADHD. Consistent with previous studies, differences in functional activation of the amygdala, fusiform gyrus, cerebellum, mesolimbic, and temporal lobe cortical regions of the brain during a task evaluating facial expressions were noted in AD compared to TCs. Differences in the neural activity in these brain regions were also observed in children diagnosed with AD compared to those diagnosed with ADHD. Overall decreased neural activity was observed during the faces task performance in the AD group compared to the other two groups, a finding consistent with studies using adults. Both TC and ADHD control groups showed increased inferior frontal cortex activity compared to the AD group. Significant activity was present in both TC and ADHD control groups in the insula which was absent in the AD group; this is consistent with other studies showing dysfunction of the mesolimbic system in children with AD. Although frontostriatal and mesolimbic systems appear to be affected in AD, these deficits were not in the same attentional networks which are dysfunctional in children diagnosed with ADHD.

Autism and related disorders

The pervasive developmental disorders are a group of neurodevelopmental disorders that include autistic disorder, Asperger's disorder, pervasive developmental disorder - not otherwise specified (PDD-NOS), childhood disintegrative disorder (CDD), and Rett's disorder. All feature childhood onset with a constellation of symptoms spanning social interaction and communication and including atypical behavior patterns. The first three disorders (autistic disorder, Asperger's disorder, and PDD-NOS) are currently referred to as autism spectrum disorders, reflecting divergent phenotypic and etiological characteristics compared to Rett's disorder and CDD. This chapter reviews research and clinical information to appropriate medical diagnosis and treatment.