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Shreya Bhat, U. Rajendra Acharya, Hojjat Adeli*, G. Muralidhar Bairy and Amir Adeli
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people are brilliant in mathematical calculations, possess normal until 1824months and then regresses to autistic
high memory power, and have extraordinary artistic and symptoms; childhood disintegrative disorder, a rare dis-
musical abilities. For example, an autistic systems admin- order affecting social, motor, and language skills (NIMH,
istrator named Gary McKinnon hacked most of the US 2014); and Rett syndrome, where mutations are linked to
government computers in 2002 (Kushner, 2011) and dis- the X-chromosome and are generally seen in girls (Chah-
covered multiple errors in their system. Table 1 describes rour etal., 2008).
three major types of ASD. Table 2 presents autism catego- Seizure in epileptic patients hampers their neurologi-
rization according to the latest clinical research. cal function, which in turn affects the social functioning
In addition to the three major types of autism of the brain (Mammone et al., 2012; Martis et al., 2013;
described in Table 1, there are several other less common Hearld, 2014; Strzelecka, 2014). Around 25% of children
types, termed as pervasive developmental disorders: with autism develop seizures (Scassellati, 2005). Accord-
regressive autistic spectrum disorder, where a child is ing to Gabis et al. (2005), the frequency of epilepsy in
Table 2Autism categorization according to the latest clinical Stereotyped behavior, impaired social interaction, and
research (Venker etal., 2013). weak synaptic transmission are associated with the irreg-
ular microglia-mediated synaptic pruning (Zhan et al.,
Types Clinical features
2014). The different types of brain cells are present in the
Persistently Difficulty with daily living activities, self- six distinct layers of cortex responsible for learning and
severe injurious behavior, severe cognitive disability memory. Changes in genetic structure vary the formation
Persistently Impairment in social interaction and
of cortex layers, leading to patches of disorganization in
moderate communication
Improving Improvement in development due to the cortex (Hamilton, 2014).
behavioral therapies Apart from genetic factors contributing to autism,
Worsening Intensive and self-injurious behavior environmental factors including mercury, radiation, and
diesel exhaust have been implicated. Further, mater-
nal viral infections, valproic acid and thalidomide used
during pregnancy, and exposure to pesticides have been
autistic children is higher. Autistic girls have a higher
reported to affect the central nervous system of the fetal
rate of epilepsy compared with boys, thus explaining the
brain (CDC, 2014). Krakowiak et al. (2012) associated a
cause of lower analyzing ability in autistic girls.
mothers metabolic conditions during pregnancy to ASD,
developmental delay, and cognitive impairment in the off-
spring. It has also been found that gestational maternal
Factors causing autism hypothyroxinemia is linked to ASD (Roman etal., 2013).
Autism is a neurobiological abnormality affecting the
Various studies and experiment-based analyses have size of the corpus callosum (He etal., 2010), a collection
attempted to provide probable causes of autism, summa- of nerve fibers connecting the two hemispheres (left and
rized in Figure 4. right) of the brain and playing a major role in the trans-
The gene expression is varied due to copy number var- mission of sensory, motor, and cognitive information.
iations or environmental toxins. Welburg (2011) reviewed Agenesis of the corpus callosum contributes to develop-
the role of genetic variants and copy number variations in ing autism, depicted in Figure 5 (Paul etal., 2014). Zielin-
ASDs. Few cases of autism are due to de novo mutations ski etal. (2014) reported increased cortical thinning in the
(Iossifov etal., 2012). The de novo genes are responsible frontal lobe, parietal lobe, occipital lobe, and the entire
for neuron motility, axon guidance, and synaptic devel- cortex of the ASD subjects.
opment (Gilman etal., 2011). Studies reveal that de novo Neuroimaging techniques have shown that children
copy number variations (structural changes) are more suffering from ASD possess anomalous brain connectiv-
common in autistic children compared with normal chil- ity. The intrinsic wiring potential of a brain region cor-
dren, as illustrated in Figure 2B (Levy etal., 2011; Sanders responds to lower wiring costs associated with shorter
et al., 2011). According to the latest research on genet- geodesic distances. The geodesic distances capture the
ics, the mutation of CHD8 (chromodomain helicase DNA complex surface of the brain. It has been observed that
binding protein 8) gene is linked to autism, resulting in the brains intrinsic connectivity differs in ASD subjects
macrocephaly and wide set eyes (Bernier et al., 2014). compared with normal subjects (Figure 6), and hence, the
wiring costs in autistic subjects are significantly reduced
(Ecker and Murphy, 2014). It has been found that func-
tional connectivity with other brain regions is decreased
within the frontal and temporal cortical regions of the
ASD brain (Tyszka et al., 2014). The transfer of informa-
tion is reduced due to less specialized autistic brain,
i.e., overconnectivity between neural assemblies (Misic
etal., 2014) and underconnectivity of the functional brain
regions (Mostofsky and Ewen, 2011; Just et al., 2012),
resulting in language impairment (Verly etal., 2013) and
reduced learning rate (Schipul etal., 2012).
Dinstein etal. (2011) reported weak interhemispheric
neural synchronization (Anderson et al., 2011) in tod-
Figure 4Possible causes of ASD. dlers with autism. The disrupted neural synchronization
Intrinsic wiring of
the brain
Minimum distance between the two different points along the cortical surface
(Geodesic distance)
Shorter geodesic
distance Significantly lower
geodesic distance due
to the abnormal
connectivity
and comprehension (Jones etal., 2014). The left temporal A recent development is automated electroencepha-
cortex activity is responsible for social language compre- logram-based diagnosis (Adeli and Ghosh-Dastidar, 2010;
hension in typically developing children, but it is reduced Cong et al., 2013; Kimiskidis et al., 2013; Herrera et al.,
in autistic children and the activity rate decreases with 2013) of ASD (Ahmadlou etal., 2010, 2012a,b) using three
age (Eyler etal., 2012). The early diagnosis of lateralized different computational paradigms of signal processing
abnormalities of temporal cortex processing can lead to such as wavelets (Tao etal., 2012; Xiang and Liang, 2012;
early neurodevelopmental pathology in autism. Kodogiannis et al., 2013), neural networks (Graf et al.,
Stevenson etal. (2014) reported on the link between 2012; Alexandridis, 2013; Celikoglu, 2013; Zhang and Ge,
multisensory temporal function and speech processing in 2013), and nonlinear analysis (Acharya etal., 2012, 2013)
ASD individuals. The ASD and typically developing par- and chaos theory (Cen etal., 2013; Hsu, 2013). This is the
ticipants underwent three tasks: (a) an audiovisual sim- subject of another review article by the authors (Bhat
ultaneity judgment task that includes single stimulus per etal., 2014).
run, audio, and visual-leading stimuli, (b) a McGurk task
including audio only, visual only, and audiovisual presen-
tations, and (c) auditory and visual temporal-order judg-
ment tasks including run with auditory and visual stimuli. Therapies
The sensory representations are the building blocks of
higher order domain of speech perception. They observed Intervention methods can enhance social engagement
weak binding between the multisensory temporal func- and reciprocity in autistic children. Infants and toddlers
tion and audiovisual speech processing using the McBurk at risk for ASD are introduced to learning therapies, and
effect that in turn causes communication impairment in parent-child interactions are enhanced to develop inter-
ASD individuals. active and communicative skills in toddlers at high risk
(Dawson, 2008). Multisensory speech integration ability Iuculano et al. (2014) studied the brain activity pat-
is enhanced when ASD children enter adolescence due to terns in the ASD and typically developing children while
plausible causes such as hormonal changes after puberty, solving complex numerical problems. ASD children show
differential myelination patterns along the white matter different multivariate activation patterns in cortical regions
tracts, and potential increases in social interaction (Foxe involved in perceptual skills and prove that they have better
etal., 2013). problem-solving ability. This ability can act as a boon to the
Rodriguez and Kern (2011) suggest that therapies autistic population and improve the quality of life.
addressing neuroinflammation can be introduced to A summary of the current psychological therapies
control microglial activation and enhance neuronal con- used in the treatment of ASD is presented in Table 3.
nection. The concentration of methionine, cystine, and
glutathione in ASD children is less, and oxidized glu-
tathione concentration is high. The lower concentration of
cystine in autistic children results in high oxidative stress.
Conclusion
Thus, zonisamide, an antiepileptic drug, can be admin-
Autism is a neurodevelopmental disorder that cannot be
istered that enhances the influx of cystine to reduce the
cured, but measures can be taken to convert this disabil-
oxidative stress (Ghanizadeh, 2011).
ity to ability. Studies have revealed that alterations in the
Lai etal. (2012) reported that the left inferior frontal
chromosome structure due to environmental factors, vari-
gyrus in ASD subjects is highly activated during song stim-
ations in the neural connectivity, and different parts of the
ulation but not speech stimulation. Since musical abilities
brain converge to autistic symptoms. Atypical behavior in
are preserved due to increased neural connectivity and
children arises after 1824 months, but the identification
sensitivity for song, musical therapies can be introduced
of phenotypic, behavioral, and neurophysiological risk
to improve verbal communication in the ASD population.
indices with the help of neuroimaging techniques can
Few ASD individuals possess extraordinary cognitive
determine the early signs of the disorder. Advances in sci-
strengths in different domains such as problem solving,
entific understanding of ASDs help in the innovation of
art, music, and innovative skills.
several pharmacotherapies. The increase in parent-child
interactions, applied behavioral analysis, developmental
psychopathology, cognitive neuroscience, and neurobi-
Table 3Summary of psychological therapies in the treatment of
ology has led to the development of effective treatments
ASD. after the early diagnosis of autistic symptoms.
Neurofeedback training
and speech therapy
Enhancement in
cognitive skills
Karimi
etal., 2011
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