Monday, April 27, 2009

Different MRI Findings in Autism - Autism not a Single Entity


A research group from France seemed surprised at wide variations in MRI findings seen among children diagnosed with autism, but they shouldn't have. Though the group took care to exclude cases of Aspergers and PDD-NOS, as well as a significant list of exclusionary criteria, half of the children had MRI abnormalities, and within this group, very different MRI abnormalities were seen - white matter and gray matter (e.g. micropachygyria) abnormalities, different brain regions - e.g. temporal lobe, callosal fibers, etc.

Excerpt: "Such unusual association of MRI abnormalities is, to our knowledge, not linked to any specific pediatric pathology."

Studies such as this point out the problems of using only behavioral criteria to make the diagnosis of autism. In this study, a multidisciplinary team consisting for child psychiatrists, child psychologists, and speech therapists were used to make the diagnosis. With no hubris intended, we think a neurologist should be included on every autism team. Understanding the specific neurological challenges a child faces can help much more than a more one-size-fits-all approach to intervention.

When we have assessed children with an autism or possible autism diagnosis, we have seen the same very wide clinical variation in terms of neurological exam - you would not treat a child with visual processing disorders with purely behavioral modification, nor a child with auditory and language processing problems with facial recognition training.

Historically, autism was first recognized as an entity by a psychiatrist, but as it becomes even more clear that the behavioral label subsumes many different neurological conditions, it's time for business-as-usual to come to an end.

MRI Abnormalities in Autism pdf

4 comments:

  1. Do you know of any other MRI posts on Autism? I'm interested in this subject and would like to read up on it.

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  2. Here will be a nice site for you: http://www.pubmedcentral.nih.gov/

    It's pubmedcentral - they post full-length scientific articles for free. Put in "mri" and "autism" and look at what pops up!

    Happy reading!

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  3. Anonymous7:24 PM

    SIDS, Autism, Autism Spectrum Disorder, Plagiocephaly, etc. are all
    conditions that the medical profession is trying to treat.
    The SIDS back sleep (Supine) sleep recommendations began in 1992
    The SIDS "Back to Sleep" campaign began in 1994.
    In 1996 the AAP SIDS Task Force, led by Dr. John Kattwinkel recommended the supine sleep position and not the side(lateral) or front(prone).
    THe Netherlands began their SIDS Back to Sleep Campaign in 1987.
    Sleep is necessary for memory consolidation, declarative learning, and procedural learning.


    The following are useful articles which discuss many of these issues indepth:
    American Academy of Pediatrics Task Force on Infant Positioning and SIDS. Positioning and SIDS. Pediatrics. 1992;89:1120-1126
    Hogberg U, Bergstrom E. Suffocated Prone: The Iatrogenic Tragedy of SIDS. American Journal of Public Health. 2000;90:527-531
    National Infant Sleep Position Household Survey. Summary Data. updated: 10/16/08 Website: http://dccwww.bumc.bu.edu/ChimeNisp/NISP_Data.asp
    Kattwinkel J, Hauck F.R., Moon R.Y., Malloy M and Willinger M Infant Death Syndrome: In Reply, Bed Sharing With Unimpaired Parents Is Not an Important Risk for Sudden. Pediatrics 2006;117;994-996
    Buzsáki, G. 1989. Two-stage model of memory trace formation: A role for “noisy” brain states. Neuroscience 31: 551–570.
    Hasselmo, M.E. 1999. Neuromodulation: Acetylcholine and memory consolidation. Trends Cogn. Sci. 3: 351–359.
    Wierzynski DM, Lubenov EV, Gu M, Siapas AG. State-Dependent Spike-Timing Relationships between Hippocampal and Prefrontal Circuits during Sleep. Neuron 61, 587-596, February 26, 2009
    Walker MP, Stickgold R. Sleep, Memory, and Plasticity. Annu. Rev. Psychol. 2006. 57: 139-66
    Gais S, Born J. Declarative memory consolidation: Mechanisms acting during human sleep. Learn Mem. 2004 Nov-Dec; 11(6): 679-685
    Davis BE, Moon RY, Sachs HC, Ottolini MC. Effects of sleep position on infant motor development. Pediatrics. 1998 Nov; 102(5):1135-40.
    Skadberg BT, Markestad T. Consequences of Getting the Head Covered During Sleep in Infancy. Pediatrics 1997;100;e6
    AJ Williams, RD Jitendra, JB Phillips, Y Lin, T McCabe, FC Tortella. Neuroprotective Efficacy and Therapeutic Window of the High-Affinity N-Methyl-D-aspartate Antagonist Conantokin-G: In Vitro (Primary Cerebellar Neurons) and In Vivo (Rat Model of Transient Focal Brain Ischemia) Studies1
    Stradling JR, Thomas G, Warley AR, Williams P, Freeland A. Effect of adenotonsillectomy on nocturnal hypoxaemia, sleep disturbance, and symptoms in snoring children. Lancet. 1990;335 :249 –253

    Also see:
    The ‘theory of mind’ (ToM) hypothesis of autism. Tom is an hypothesis first published in 1985.

    Data:
    Individuals with Disabilities Education Act (IDEA) Data website:
    http://www.ideadata.org/PartBChildCount.asp
    Pregnancy Risk Assessment Monitoring System (PRAMS) sleep position data:
    http://www.cdc.gov/prams/2002PRAMSSurvReport/MultiStateExhibits/Multistates16.htm
    Centers for Disease Control (CDC) Birth Data:
    http://www.cdc.gov/nchs/births.htm
    2006 Median Income Data: - U.S. Department of Housing and Urban Development
    NOTICE PDR-2006-01

    Autism Spectrum Disorders, Asperger's Syndrome, and Pervasive Developmental Disorders - Not Otherwise specified (PDD-NOS)
    Gastrointestinal Disorders also known as GER is a common comorbidity
    Autism patients tend to have minicolumn abnormalities and increased amounts of white matter
    Casanova MF, van Kooten IA, Switala AE, Ven Engeland H, Heinsen H, Steinbusch HW, Hof PR, Trippe J, Stone J, Schmitz C. Minicolumnar abnormalities in autism. Acta Neuropathol. 2006 Sep; 112(3); 287-303.
    Mostofsky SH, Burgess MP, Larson JCG. Increased motor cortex white matter volume predicts motor impairment in autism. Brain (2007), 130, 2117-2122

    Maternal smoking decreased significantly between 1990 and 2002
    Infant suffocation deaths increased 14% per year on average between 1996 and 2004
    Centers for Disease Control. Smoking & Tobacco Use - Morbidity and Mortality Weekly Reports (MMWRs) – Smoking During Pregnancy – United States, 1990-2002 – October 7, 2004 / Vol. 53/ No. 39 http://www.cdc.gov/tobacco/data_statistics/MMWR/2004/mm5339_highlights.htm
    Shapiro-Mendoza CK, Kimball M, Tomashek KM, Anderson RN, Blanding S.US Infant Mortality Trends Attributable to Accidental Suffocation and Strangulation in Bed From 1984 Through 2004: Are Rates Increasing? Pediatrics 2009;123;533-539

    Here is a good article on diagnosing this:
    Filipek P, Accardo P, Ashwal S, Baranek G, Cook E, Dawson G, Gordon B, Gravel J, Johnson C, Kallen R, Levy S, Minshew N, Ozonoff S, Prizant B, Rapin I, Rogers S, Stone W, Teplin S, Tuchman R, Volkmar F. Practice parameter: Screening and diagnosis of autism Report of the Quality Standards Subcommittee of the American Academy of Neurology and the Child Neurology Society NEUROLOGY 2000;55:468–479 http://internet.dscc.uic.edu/forms/medicalhome/AutismRef.pdf

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  4. I like this information because it is very important for me because I suffer autism.Brian N. Giddens

    ReplyDelete