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Orla Foley
Autism: Impaired Brain Activity Explains Poor Emotion Controlhttp://www.medscape.com/viewarticle/839793The inability to regulate emotion in patients with autism spectrum disorders (ASDs) appears to be due to impaired brain activity, new research shows.Functional magnetic resonance imaging (fMRI) scans of 30 adult participants showed that those with ASD had less change in dorsolateral prefrontal cortex activation compared with their healthy counterparts when undergoing a positive and negative emotion regulation (ER) exercise.The investigators note that the findings suggest "a potential mechanistic account" of impaired ER in those with ASD."This is actually the second study to look at this. The Yale Child Study Center asked a similar question last year, but they only looked at negative emotion regulation," senior author Gabriel S. Dichter, PhD, associate professor of psychiatry at the University of North Carolina Chapel Hill School of Medicine and investigator at the Carolina Institute for Developmental Disabilities, told Medscape Medical News. "We are the first group to include positive regulation as well, which we think is critical for learning how to like people and make friends," he added.The study was published online January 25 in the Journal of Autism Developmental Disorder. Checks and Balances "ER is important not only for understanding associated features of ASD, but is relevant to…symptoms of social communication that define ASD as well," write the researchers."For example, emotional awareness, recognition of emotion experience in others, and impaired identification and expression of social gestures may all reflect impaired modulation of social- emotional information processing because they require the adjustment of internal affective experiences to changing environmental conditions," they add.The goal of the study was to assess brain activation during "cognitive reappraisal," which was defined as "a form of consciously deployed ER that…effectively modulates subjective responses via a reinterpretation of the meaning of emotional challenges."A total of 15 neurotypical adults (control group; 87% men; mean age, 27.4 years) were included in the study, as were 15 adults with ASD (87% men; mean age, 26.1 years). All participants except one member of the control group were right-handed.Cognitive reappraisal training for both groups included the display of sample images and instruction on how to "think positive" or to "think negative" about a neutral face ― even if they actually felt differently about the image.After training, MRI scans, eyetracking, and pupilometry were used to measure changes in responses."We're the first group to collect these measures in the scanner, which serve as a form of checks and balances to make sure participants were indeed doing what we asked them to do," reported Dr Dichter.Core Feature of the Disorder Results showed that after being told to think positively about a set of faces, the ASD group had significantly less activation increases in the right nucleus accumbens, as well as in a cluster that included both the left nucleus accumbens and the putamen (all, P < .001), vs the control group.This deactivation, especially in the nucleus accumbens, "a central hub of the brain's dopaminergic mesolimbic reward system," may contribute to decreases in the "motivational salience of social information" for those with ASD, note the investigators.When told to think negatively about certain faces, those with ASD showed less increases in left and right bilateral amygdala activation compared with their healthy peers (all, P < .01)."The diminished capacity to decrease amygdala responses in social contexts may play a causal mechanistic role in the expression of a range of behavioral problems…commonly seen in ASD, including tantrums, aggression, self-injury, and irritability," the researchers write.Being asked to increase positive or negative ERs in relation to the faces also corresponded with less activation increases in the ASD group than in the control group in the middle frontal gyrus and left superior frontal gyrus (all, P < .01).There were no between-group differences in pupilometry, looking time, or "subjective rating of faces during reappraisal."The investigators note in a release that improving activation could help those with ASD to both regulate their emotions and improve symptoms associated with the disorder."Although autism is diagnosed on the basis of social impairment and repetitive behaviors, the importance of emotion regulation and all the behaviors that come with it are very real and should be a focus of clinical services," added Dr Dichter in the same release.He noted that the FDA has only approved two medications for autism ― but they only treat irritability and aggression."We've known for a while that we need to pay attention to [ER] in people with autism, but we think these data suggest a neural basis for these problems and add credence to their ubiquity as core features of the disorder," he saidHe added that when clinicians deliver a diagnosis of ASD to a family, they should offer psychoeducation relating to the disorder's core symptoms as well as impaired emotion regulation.J Autism Dev Disord. Published online January 25, 2015. Abstract
