Language Functioning Optimal Outcome Children--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)儿童的预后已有显著改善。这些儿童中的一小部分似乎达到了所谓的“最佳结局”，即认知和适应功能在正常范围内，他们不再符合任何自闭症的标准。很少或根本没有关于这类儿童或他们的状况的严格记录，最近的一些论文表明，这样的结果对自闭症儿童来说不是一个现实的目标；因此，即使是存在最佳结果组也仍然存在争议。这些孩子中没有一个被详细研究过，也没有人被跟踪到青春期，所以他们的功能在多大程度上真正正常化还不得而知。由于自闭症的语言障碍如此普遍和集中，即使在结果最佳的儿童中，残余的语言困难可能也会持续存在。对一组这类儿童的初步研究表明，他们表现出语言功能正常化的许多领域，以及仍然表现出损害的特定领域。我们建议研究一组青春期早期到中期的儿童，并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会产生一个重要的问题：这些最佳结果儿童认知过程显著改善的潜在神经机制是什么？可以假设，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，即使是正常的行为表现也是如此。这将意味着可以招募替代的神经通路和网络来完成一项任务，使其达到行为正常的水平，这表明存在多种发育途径来实现成功的功能。另一方面，表现水平正常的儿童的最佳结果可能会显示出典型的大脑激活模式，这表明只有正常使用神经网络的补救措施才能导致正常的任务表现；这将意味着非常早期干预的重要性。为了解决这个问题，将进行语法和面部处理的fMRI任务，并对选定的结构变量进行探索性分析，以确定最成功的干预是否似乎对结构正常的大脑起作用。

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.