Language Functioning in Optimal Outcome Children with a History of Autism

描述（由申请人提供）：接受强化早期干预的自闭症谱系障碍（ASD）儿童预后显著改善。这些儿童中的少数似乎达到了所谓的“最佳结果”，即认知和适应功能在正常范围内，他们不再符合任何ASD的标准。很少或根本没有对这些儿童或他们的状态进行严格的记录，最近的一些论文表明，对ASD儿童来说，这样的结果是不现实的；因此，即使是最优结果组的存在仍然存在争议。这些孩子都没有被详细研究过，也没有被跟踪到青春期，所以他们的功能真正正常化的程度是未知的。由于ASD中的语言障碍是如此普遍和核心，因此即使在结果最佳的儿童中，残留的语言障碍也可能持续存在。对一组这样的孩子进行的初步研究表明，他们表现出许多正常语言功能的领域，以及仍然表现出障碍的特定领域。我们建议研究一组处于青春期早期到中期的儿童，全面评估他们的语言、认知和适应能力。从我们的初步结果中自然产生了一个重要的问题：在这些获得最佳结果的儿童中，认知过程显著改善的潜在神经机制是什么？可以假设，即使在正常的行为表现下，他们对早期语言的非典型习得导致了语言过程的非典型神经表征。这意味着，在行为正常的水平上，可能会招募其他的神经通路和网络来执行任务，这表明成功运作的多种发育途径的存在。另一方面，表现水平正常的儿童可能表现出典型的大脑激活模式，这表明只有使神经网络使用正常化的补救措施才能导致正常的任务表现；这就暗示了早期干预的重要性。语法和面部处理的功能磁共振成像任务将被执行来解决这个问题，并对选择的结构变量进行探索性分析，以检查是否最成功的干预似乎在结构正常的大脑上运作。

DESCRIPTION (provided by applicant): Prognosis for children with Autism Spectrum Disorder (ASD) receiving intensive early intervention has improved substantially. A minority of these children appear to reach what may be called "optimal outcome", in which cognitive and adaptive functioning are within normal limits and they no longer meet criteria for any ASD. Little or no rigorous documentation of such children or their status has been attempted and some recent papers have suggested that such an outcome is not a realistic aim for ASD children; therefore, even the existence of the optimal outcome group remains controversial. None of these children has been studied in detail, or followed into adolescence, so the extent to which their functioning has truly normalized is not known. Since language difficulties in ASD are so pervasive and central, residual language difficulties might be expected to persist even in children with optimal outcomes. Preliminary studies on a group of such children suggest that they show many areas of normalized language functioning as well as specific areas in which impairment is still demonstrated. We propose to study a group of these children in early to mid- adolescence and fully assess their language, cognitive, and adaptive competence. One important question naturally arises from our preliminary results: what are the underlying neural mechanisms of the striking improvement of cognitive processes in these optimal outcome children? It could be hypothesized that their atypical acquisition of early language resulted in an atypical neural representation of language processes, even with normal behavioral performance. This would imply that alternative neural pathways and networks may be recruited to perform a task to behaviorally normal levels, suggesting the existence of multiple developmental pathways to successful functioning. On the other hand, the optimal outcome children with normal performance levels might show typical patterns of brain activation, suggesting that only remediation that normalizes the use of neural networks can result in normal task performance; this would have implications for the importance of very early intervention. fMRI tasks of syntax and face processing will be administered to address this question, and exploratory analysis of selected structural variables will be examined to see if the most successful intervention appears to operate on a structurally normal brain.