A few autism papers

i. The anterior insula in autism: Under-connected and under-examined.

“While the past decade has witnessed a proliferation of neuroimaging studies of autism, theoretical approaches for understanding systems-level brain abnormalities remain poorly developed. We propose a novel anterior insula-based systems-level model for investigating the neural basis of autism, synthesizing recent advances in brain network functional connectivity with converging evidence from neuroimaging studies in autism. The anterior insula is involved in interoceptive, affective and empathic processes, and emerging evidence suggests it is part of a “salience network” integrating external sensory stimuli with internal states. Network analysis indicates that the anterior insula is uniquely positioned as a hub mediating interactions between large-scale networks involved in externally- and internally-oriented cognitive processing. A recent meta-analysis identifies the anterior insula as a consistent locus of hypoactivity in autism. We suggest that dysfunctional anterior insula connectivity plays an important role in autism. […]

Increasing evidence for abnormal brain connectivity in autism comes from studies using functional connectivity measures […] These findings support the hypothesis that under-connectivity between specific brain regions is a characteristic feature of ASD. To date, however, few studies have examined functional connectivity within and between key large-scale canonical brain networks in autism […] The majority of published studies to date have examined connectivity of specific individual brain regions, without a broader theoretically driven systems-level approach.

We propose that a systems-level approach is critical for understanding the neurobiology of autism, and that the anterior insula is a key node in coordinating brain network interactions, due to its unique anatomy, location, function, and connectivity.”

ii. Romantic Relationships and Relationship Satisfaction Among Adults With Asperger Syndrome and High‐Functioning Autism.

“Participants, 31 recruited via an outpatient clinic and 198 via an online survey, were asked to answer a number of self-report questionnaires. The total sample comprised 229 high-functioning adults with ASD (40% males, average age: 35 years). […] Of the total sample, 73% indicated romantic relationship experience and only 7% had no desire to be in a romantic relationship. ASD individuals whose partner was also on the autism spectrum were significantly more satisfied with their relationship than those with neurotypical partners. Severity of autism, schizoid symptoms, empathy skills, and need for social support were not correlated with relationship status. […] Our findings indicate that the vast majority of high-functioning adults with ASD are interested in romantic relationships.”

Those results are very different from other results in the field – for example: “[a] meta-analysis of follow-up studies examining outcomes of ASD individuals revealed that, [o]n average only 14% of the individuals included in the reviewed studies were married or ha[d] a long-term, intimate relationship (Howlin, 2012)” – and one major reason is that they only include high-functioning autistics. I feel sort of iffy about the validity of the selection method used for procuring the online sample, this may also be a major factor (almost one third of them had a university degree so this is definitely not a random sample of high-functioning autistics; ‘high-functioning’ autistics are not that high-functioning in the general setting. Also, the sex ratio is very skewed as 60% of the participants in the study were female. A sex ratio like that may not sound like a big problem, but it is a major problem because a substantial majority of individuals with mild autism are males. Whereas the sex ratio is almost equal in the context of syndromic ASD, non-syndromic ASD is much more prevalent in males, with sex ratios approaching 1:7 in milder cases (link). These people are definitely looking at the milder cases, which means that a sample which skews female will not be remotely similar to most random samples of such individuals taken in the community setting. And this matters because females do better than males. A discussion can be had about to which extent women are under-diagnosed, but I have not seen data convincing me this is a major problem. It’s important to keep in mind in that context that the autism diagnosis is not based on phenotype alone, but on a phenotype-environment interaction; if you have what might be termed ‘an autistic phenotype’ but you are not suffering any significant ill effects as a result of this because you’re able to compensate relatively well (i.e. you are able to handle ‘the environment’ reasonably well despite the neurological makeup you’ve ended up with), you should not get an autism diagnosis – a diagnostic requirement is ‘clinically significant impairment in functioning’.

Anyway some more related data from the publication:

“Studies that analyze outcomes exclusively for ASD adults without intellectual impairment are rare. […] Engström, Ekström, and Emilsson (2003) recruited previous patients with an ASD diagnosis from four psychiatric clinics in Sweden. They reported that 5 (31%) of 16 adults with ASD had ”some form of relation with a partner.” Hofvander et al. (2009) analyzed data from 122 participants who had been referred to outpatient clinics for autism diagnosis. They found that 19 (16%) of all participants had lived in a long-term relationship.
Renty and Roeyers (2006) […] reported that at the time of the[ir] study 19% of 58 ASD adults had a romantic relationship and 8.6% were married or living with a partner. Cederlund, Hagberg, Billstedt, Gillberg, and Gillberg (2008) conducted a follow-up study of male individuals (aged 16–36 years) who had been diagnosed with Asperger syndrome at least 5 years before. […] at the time of the study, three (4%) [out of 76 male ASD individuals] of them were living in a long-term romantic relationship and 10 (13%) had had romantic relationships in the past.”

A few more data and observations from the study:

“A total of 166 (73%) of the 229 participants endorsed currently being in a romantic relationship or having a history of being in a relationship; 100 (44%) reported current involvement in a romantic relationship; 66 (29%) endorsed that they were currently single but have a history of involvement in a romantic relationship; and 63 (27%) participants did not have any experience with romantic relationships. […] Participants without any romantic relationship experience were significantly more likely to be male […] According to participants’ self-report, one fifth (20%) of the 100 participants who were currently involved in a romantic relationship were with an ASD partner. […] Of the participants who were currently single, 65% said that contact with another person was too exhausting for them, 61% were afraid that they would not be able to fulfil the expectations of a romantic partner, and 57% said that they did not know how they could find and get involved with a partner; and 50% stated that they did not know how a romantic relationship works or how they would be expected to behave in a romantic relationship”

“[P]revious studies that exclusively examined adults with ASD without intellectual impairment reported lower levels of romantic relationship experience than the current study, with numbers varying between 16% and 31% […] The results of our study can be best compared with the results of Hofvander et al. (2009) and Renty and Roeyers (2006): They selected their samples […] using methods that are comparable to ours. Hofvander et al. (2009) found that 16% of their participants have had romantic relationship experience in the past, compared to 29% in our sample; and Renty and Roeyers (2006) report that 28% of their participants were either married or engaged in a romantic relationship at the time of their study, compared to 44% in our study. […] Compared to typically developed individuals the percentage of ASD individuals with a romantic relationship partner is relatively low (Weimann, 2010). In the group aged 27–59 years, 68% of German males live together with a partner, 27% are single, and 5% still live with their parents. In the same age group, 73% of all females live with a partner, 26% live on their own, and 2% still live with their parents.”

“As our results show, it is not the case that male ASD individuals do not feel a need for romantic relationships. In fact, the contrary is true. Single males had a greater desire to be in a romantic relationship than single females, and males were more distressed than females about not being in a romantic relationship.” (…maybe in part because the females who were single were more likely than the males who were single to be single by choice?)

“Our findings showed that being with a partner who also has an ASD diagnosis makes a romantic relationship more satisfying for ASD individuals. None of the participants, who had been with a partner in the past but then separated, had been together with an ASD partner. This might indicate that once a person with ASD has found a partner who is also on the spectrum, a relationship might be very stable and long lasting.”

Reward Processing in Autism.

“The social motivation hypothesis of autism posits that infants with autism do not experience social stimuli as rewarding, thereby leading to a cascade of potentially negative consequences for later development. […] Here we use functional magnetic resonance imaging to examine social and monetary rewarded implicit learning in children with and without autism spectrum disorders (ASD). Sixteen males with ASD and sixteen age- and IQ-matched typically developing (TD) males were scanned while performing two versions of a rewarded implicit learning task. In addition to examining responses to reward, we investigated the neural circuitry supporting rewarded learning and the relationship between these factors and social development. We found diminished neural responses to both social and monetary rewards in ASD, with a pronounced reduction in response to social rewards (SR). […] Moreover, we show a relationship between ventral striatum activity and social reciprocity in TD children. Together, these data support the hypothesis that children with ASD have diminished neural responses to SR, and that this deficit relates to social learning impairments. […] When we examined the general neural response to monetary and social reward events, we discovered that only TD children showed VS [ventral striatum] activity for both reward types, whereas ASD children did not demonstrate a significant response to either monetary or SR. However, significant between-group differences were shown only for SR, suggesting that children with ASD may be specifically impaired on processing SR.”

I’m not quite sure I buy that the methodology captures what it is supposed to capture (“The SR feedback consisted of a picture of a smiling woman with the words “That’s Right!” in green text for correct trials and a picture of the same woman with a sad face along with the words “That’s Wrong” in red text for incorrect trials”) (this is supposed to be the ‘social reward feedback’), but on the other hand: “The chosen reward stimuli, faces and coins, are consistent with those used in previous studies of reward processing” (so either multiple studies are of dubious quality, or this kind of method actually ‘works’ – but I don’t know enough about the field to tell which of the two conclusions apply).

iv. 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, while granting 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 picture 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.”

v. Stalking, and Social and Romantic Functioning Among Adolescents and Adults with Autism Spectrum Disorder.

“We examine the nature and predictors of social and romantic functioning in adolescents and adults with ASD. Parental reports were obtained for 25 ASD adolescents and adults (13-36 years), and 38 typical adolescents and adults (13-30 years). The ASD group relied less upon peers and friends for social (OR = 52.16, p < .01) and romantic learning (OR = 38.25, p < .01). Individuals with ASD were more likely to engage in inappropriate courting behaviours (χ2 df = 19 = 3168.74, p < .001) and were more likely to focus their attention upon celebrities, strangers, colleagues, and ex-partners (χ2 df = 5 =2335.40, p < .001), and to pursue their target longer than controls (t = -2.23, df = 18.79, p < .05).”

“Examination of relationships the individuals were reported to have had with the target of their social or romantic interest, indicated that ASD adolescents and adults sought to initiate fewer social and romantic relationships but across a wider variety of people, such as strangers, colleagues, acquaintances, friends, ex-partners, and celebrities. […] typically developing peers […] were more likely to target colleagues, acquaintances, friends, and ex-partners in their relationship attempts, whilst the ASD group targeted these less frequently than expected, and attempted to initiate relationships significantly more frequently than is typical, with strangers and celebrities. […] In attempting to pursue and initiate social and romantic relationships, the ASD group were reported to display a much wider variety of courtship behaviours than the typical group. […] ASD adolescents and adults were more likely to touch the person of interest inappropriately, believe that the target must reciprocate their feelings, show obsessional interest, make inappropriate comments, monitor the person’s activities, follow them, pursue them in a threatening manner, make threats against the person, and threaten self-harm. ASD individuals displayed the majority of the behaviours indiscriminately across all types of targets. […] ASD adolescents and adults were also found […] to persist in their relationship pursuits for significantly longer periods of time than typical adolescents and adults when they received a negative or no response from the person or their family.”


April 4, 2017 - Posted by | autism, Neurology, Papers, Psychology

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