Optimal Outcomes in ASD: Adult Functioning, Predictors, and Mechanisms

一些人在5岁之前符合ASD的黄金标准临床标准，但最终在发育后期 没有自闭症症状，智商和适应能力在平均范围内。这项研究评价这是“最佳的” 结果“(OO)分为两组：(1)那些十几岁时参与我们的OO研究的人，现在是年轻人， 使我们能够评估他们是如何在艰难的过渡中过渡到独立和年轻的； 以及(2)那些在两岁时被我们诊断为自闭症，并在四岁时重新评估的人，现在他们十几岁， 使我们能够确定这群人中哪一个取得了最好的结果，从而及早确定 面向对象的预测因子。这两个队列都与年龄、性别和NVIQ匹配的个体进行了比较，目前 ASD和典型发育(TD)。我们假设，患有OO的年轻人将经历轻微的 完成高等教育和获得有竞争力的就业等成人里程碑的延迟，以及 有更多的焦虑，特别是简单的恐惧症和ADHD症状。我们还假设早些时候 儿童时期OO的预测因素是较轻微的社会损伤，较高的社交、沟通和适应能力， 和运动域，以及更少的重复行为。我们在第二个队列中使用功能磁共振成像(n=50) 组，总计n=150)，以测量涉及社交和语言的功能连接网络 任务，以及在休息状态下观察到的任务，以研究神经机制如何与 在OO中观察到明显的症状变化。根据之前的成像研究，我们假设， 与ASD和TD相比，OO组将显示额外模块的补偿性(非典型)连接 前额叶认知控制网络与左半球语言区的右脑同源 在语言和社交过程中，以及在休息状态下。

Some individuals meet gold-standard clinical criteria for ASD prior to age 5 but end up later in development with no symptoms of ASD, and IQ and adaptive skills in the average range. This study evaluates this “optimal outcome” (OO) in two groups: (1) those who participated in our OO research study as teens, now young adults, allowing us to evaluate how they navigate the difficult transition into independence and young adulthood; and (2) those who were diagnosed by us with ASD at age two and re-evaluated at age four, now in their teens, allowing us to identify which of this cohort has achieved optimal outcome, and thus to identify early predictors of OO. Both cohorts are compared to age-, gender-, and NVIQ-matched individuals with current ASD and with typical development (TD). We hypothesize that the young adults with OO will experience mild delays in adult milestones such as finishing higher education and obtaining competitive employment, along with greater anxiety, especially simple phobias, and ADHD symptoms. We also hypothesize that early childhood predictors of OO will be milder social impairment, higher adaptive skills in social, communication, and motor domains, and fewer repetitive behaviors. We employ fMRI in the second cohort (n=50 per study group, total n=150) to measure the functional connectivity networks that are involved in social and language tasks, and that are observed during resting state, to investigate how neural mechanisms relate to the dramatic symptom change observed in OO. Drawing on prior imaging research, we hypothesize that, compared to both ASD and TD, the OO group will show compensatory (atypical) connectivity of extra-modular prefrontal cognitive control networks and right hemisphere homologues of left-hemisphere language regions during language and social processing and during resting state.