A Lot on the Mind: Autism

In the second event hosted by Caveat NYC of a three-part series dedicated to explaining the most misunderstood neurological disorders, the focus was on autism, or autism spectrum disorder (ASD).

Of the many neurological disorders that affect the world, autism is one of the most familiar. Affecting 1 out of every 59 people, there are characteristics associated with the disorder that seem to be fairly consistent. However, a running theme at last week’s event, “A Lot on the Mind – Understanding Autism with braiNY and Spectrum Magazine,” was that if you know one person with autism, you know one person with autism. There is a huge range of behaviors that define the disorder and individuals with autism have their own unique strengths and weaknesses.

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Lisa Shulman, M.D., gives the audience background on autism spectrum disorder (ASD)

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Neuroscience and Society: Autism

When we’re trying to help people who have troubles due to autism spectrum disorders, one of the first challenges is definition: What does “autism” mean?

“Autism was and is still currently defined by behaviors,” Dana Alliance member Barry Gordon said, as researchers haven’t yet found solid biomarkers or other internal signals to identify it. “Whenever you read about autism, you might want to dig into what definitions they go into,” he said during a recent discussion at the American Academy for the Advancement of Sciences (AAAS) in Washington, DC.

Autism -Dawson - Oct2018Even definitions by behavior vary. For example, fellow presenter Daniel Geschwind said, problems with language used to be part of the diagnosis, but now doctors and other caregivers usually only count differences in social behavior and the presence of “repetitive-restrictive” behavior (like hand-flapping or always needing to do activities in the same order).

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Free Public Event on Autism

Autism and the Brain_Oct 2018.png
Autism is a mysterious and puzzling disorder. In 1943, American child psychiatrist Leo Kanner first published a paper describing 11 children who were highly intelligent but displayed “a powerful desire for aloneness” and “an obsessive insistence on persistent sameness.” He called this condition “early infantile autism.” Prior to that time, people with autism were simply called insane. Autism is now officially known as autism spectrum disorder (ASD) and, while there is a wide variation in the nature and severity of its signs, people with ASD typically have difficulty with social communication and interaction, restricted interests, and repetitive behaviors. Continue reading

AAAS: Brain-changing power of music prompts calls for more education, therapy

Growing evidence that music training can enhance certain mental abilities, can alleviate the symptoms of learning disorders, and can restore lost functions in people with neurological damage has prompted calls to increase school music programs and therapeutic treatments.

At a press conference Saturday at the annual meeting of the American Association for the Advancement of Science, Nina Kraus, a communications disorder professor at Northwestern University, and Gottfried Schlaug, an associate professor of neurology at Beth Israel Deaconess Medical Center and Harvard Medical School, summarized recent research outlining the profound ability of music to enhance or restore brain pathways and the implications of those findings for health and education.

Kraus pointed out that music is reflected literally by the brain. After hearing a sound, a person's brain waves come to mirror that melody, she said, playing several pairs of music sequences and brain waves to demonstrate. But music exerts its most profound effects after extensive training, by increasing not just the ability to learn and play music but also facility with memory, attention, and pattern recognition. In fact, she said, her work suggests that intensive music training may be key to treating or ameliorating childhood learning disabilities, as it greatly enhances the abilities that suffer the most in those conditions.

In a recent study, for instance, she found that trained musicians have a much greater ability to discern speech in noisy situations, such as crowded restaurants or bars, than those without any musical experience, a kind of pattern-recognition task some children also have great difficulty with. The finding, which appeared in the December 2009 issue of the journal Ear and Hearing, echoes research her group presented at the 2009 Society for Neuroscience meeting showing that trained musicians have enhanced abilities to focus on and memorize sounds, other abilities lacking in people with dyslexia, autism, and related disorders. This suggests, she said, that elementary and secondary schools are making a mistake when they cut out music programs. "The education and remediation possibilities of music training are very encouraging," she said.

Schlaug played several videos showing the power of melodic intonation therapy (MIT) to rewire seriously damaged brains. As we have described previously, MIT is a technique developed for treating nonfluent aphasia, or an inability to speak due to damage, usually from a stroke, to the language-processing regions in the brain's left hemisphere. During the treatment, a music therapist teaches the patient to feel out the melody of specific phrases by tapping his or her hand and then to repeat the phrases aloud in a singsong voice. Typically, the treatment course is intense, consisting of 70 to 80 sessions over several weeks.

The results can be spectacular; most patients, Schlaug said, recover significant amounts of speaking ability, and one patient even felt comfortable enough to make a short public speech. In one particularly compelling video clip, a man went from mumbling nonsense phrases to being able to recite his full mailing address after 75 therapy sessions. "These kinds of music-making therapies are very useful for patients suffering from strokes and other neurological disorders," Schlaug said. "It engages parts of the brain that are not normally engaged and links parts of the brain that are not normally linked."

Although the therapy has shown promising results, it is still in the early stages of testing, Schlaug added. If it pans out, tens of thousands of stroke victims could benefit from the therapy each year in the United States alone. The true challenge then, he said, would be gaining widespread traction for the treatment, by getting therapists to feel comfortable with the oddness of singing with their patients and by ensuring that insurance companies reimburse people for MIT sessions.

Schlaug has been a pioneer in the field of music and the brain studies; some of his research is funded by the Dana Foundation. Mentioned only obliquely in his presentation, for instance, was a four-year study he is helping to conduct that compares the cognitive abilities of children undergoing regular music training with those who are not. Not surprisingly, he and his colleagues have found that, after 15 months, children who practice music showed more improvements in motor skills and melody and rhythm identification tasks related directly to music. But after 30 months, the results seem more in line with those of Kraus and her lab, with the children beginning to show suggestive, though not significant, signs of "far transfer" benefits—increases in most distantly related skills, such as vocabulary and abstract reasoning.

–Aalok Mehta

For autism, Parkinson’s, hope for faster diagnosis

For many brain diseases, diagnosis is no exact science.
Because of the complexity of the brain and of the symptoms that it can cause,
there are often no definitive tests, and neurologists lean on years of
experience, long and painstaking observations, and educated guesses to
determine what exactly is afflicting their patients. Not only is this
frustrating for everyone involved, but in some cases a delayed diagnosis can
make a disease much more difficult or even impossible to treat successfully.

Now, scientists have made progress on faster, more objective
methods to detect at least two serious neurological disorders in which early
and correct diagnosis is vital.

A small pilot study conducted by Timothy
Roberts
and his colleagues at the Children’s Hospital of Philadelphia report
has found that a relatively unobtrusive brain-scanning technique may be useful
in detecting autism-spectrum
disorders
(ASD). These conditions, characterized by problems in
communication and social interaction, are often diagnosed after a child has
already begun school, when treatments to prevent reading and other learning
disabilities are less effective. They are also not that uncommon: A recent
study by the Centers for Disease Control and Prevention found that
almost 1 percent of children in the U.S. have an ASD
.

For the study,
reported online in the journal Autism
Research
this month, the scientists measured brain responses from 25
children with ASDs and 17 without using magnetoencephalography, in which a helmet
surrounding the head is used to measure the brain’s magnetic field. On average,
the ASD group had a tiny delay—about 11 milliseconds—in brain responses to
sounds. According to the researchers, this may be explained by one
of their previous studies
, which found that people with ASDs have reduced
amounts of white matter, or myelination, a type of insulating material that
speeds up transmission of nerve signals.

In the second study, slated
to appear in the February issue of Lancet
Neurology,
researchers from the Feinstein Institute for Medical
Research, led by David
Eidelberg
, used positron emission tomography (PET), which measures blood
flow and chemical changes in the brain, to successfully diagnose whether a person
had Parkinson’s disease, multiple system atrophy, or progressive supranuclear
palsy. These movement disorders often show nearly identical symptoms at the
start but require different types of treatments.

In 167 patients, a computer program analyzing PET results
matched the diagnosis made by experienced specialists more than 80 percent of
the time. The doctors, however, had spent an average of 2.6 years assessing the
patients before coming to their judgments.

It remains to be seen whether the results of their studies
will end up reaching the doctor’s office, as many promising brain-scan findings
have ultimately failed to be precise or accurate enough upon additional testing.
The ASD study, for instance, looked at an extremely small number of people and tested
children with an average age of 10; it’s unknown whether such a delay would
still be detectable in young children or infants, for whom early diagnosis
would offer the most advantages.

The computer program used in the PET work will likewise need
additional testing through large, double-blind studies, according to the study
authors. But if confirmed, the findings could extend beyond better diagnosis,
they say; the research may also spur drug development for movement disorders by
allowing doctors to identify candidates for clinical trials much earlier than
previously possible.

—Aalok Mehta

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