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