what in the brain causes autistic kid to repeat
Future Neurol. Author manuscript; available in PMC 2010 Dec 29.
Published in final edited form as:
Future Neurol. 2010 November; v(half-dozen): 797–805.
PMCID: PMC3011184
NIHMSID: NIHMS258788
Neural pathways for linguistic communication in autism: the potential for music-based treatments
Catherine Y Wan
aneDepartment of Neurology, Music, Linguistic communication Recovery, & Neuroimaging Laboratory, Beth Israel Deaconess Medical Eye & Harvard Medical School, Boston, MA 02215, U.s.
Gottfried Schlaug
1Department of Neurology, Music, Language Recovery, & Neuroimaging Laboratory, Beth Israel Deaconess Medical Centre & Harvard Medical School, Boston, MA 02215, Usa
Abstract
Language deficits represent the core diagnostic characteristics of autism, and some of these individuals never develop functional speech. The language deficits in autism may exist due to structural and functional abnormalities in sure language regions (due east.g., frontal and temporal), or due to altered connectivity between these brain regions. In item, a number of anatomical pathways that connect auditory and motor brain regions (e.g., the arcuate fasciculus, the uncinate fasciculus and the extreme capsule) may exist contradistinct in individuals with autism. These pathways may also provide targets for experimental treatments to facilitate communication skills in autism. Nosotros propose that music-based interventions (eastward.yard., auditory–motor mapping grooming) would take advantage of the musical strengths of these children, and are likely to engage, and possibly strengthen, the connections between frontal and temporal regions bilaterally. Such treatments have important clinical potential in facilitating expressive language in nonverbal children with autism.
Keywords: arcuate fasciculus, auditory-motor mapping preparation, autism, connectivity, intervention, language deficits, music, neuroimaging, nonverbal
Impairments in language and communication skills represent the core diagnostic features of autism or autism spectrum disorders [1]. The linguistic ability of individuals on the autism spectrum varies greatly. Up to 25% of individuals with autism spectrum disorders lack the ability to communicate with others using spoken language sounds [101]. Others take acceptable linguistic noesis coupled with abnormalities of nonliteral language, such as the comprehension of idioms [2], and some individuals display impairments in the understanding of language in context [3,4]. At nowadays, there appears to be no evidence-based intervention that consistently produces significant improvements in expressive linguistic communication in individuals with autism [5]. Deficits in communication thus present a persistent and life-long challenge for individuals with autism and their families.
To elucidate the language deficits in autism, researchers have used structural and functional imaging and neurophysiological techniques to examine potential abnormalities in classical language areas in the encephalon, such as the posterior inferior frontal gyrus (pIFG; i.eastward., Broca's region) and the posterior superior and eye temporal gyri (i.east., Wernicke'southward region). In this article, we review studies that have reported abnormalities in these key brain regions and the connections between them, and present a new experimental intervention that may provide an alternative medium to engage a network that might be aberrant, impaired or underdeveloped. Information technology is inevitable that verbal individuals volition exist over-represented in this literature, then the piece of work reviewed here may not be ideal for illuminating the mechanisms underlying the complete absenteeism of speech, as is observed in some individuals with autism. Nosotros argue that interventions that appoint the network of frontal and temporal brain regions bilaterally, such equally using alternative methods, may accept of import clinical potential, specifically in facilitating expressive language in otherwise nonverbal individuals, as well as in strengthening the underlying connections. Finally, we nowadays a music-based intervention (termed auditory–motor mapping training) and provide a rationale of why it may serve as a viable therapeutic tool in assisting individuals with autism to develop speech.
Language processing in typically developing individuals
An investigation of linguistic communication processing in autism requires an understanding of the core language regions and the underlying neural mechanisms in typically developing individuals. The 2 core regions of language consists of an anterior 'expressive' linguistic communication region with a center in the left pIFG, which may serve as a analogous center for motor planning and execution regions in the adjacent premotor and motor regions, and a posterior 'receptive' language region with a centre in the left posterior superior temporal and heart temporal gyrus, which may have different subregions that bargain with auditory feedback, matching of auditory perceptions to formed templates and a lexicon. Most of what we know about these brain regions, their interactions and their hemispheric laterality is derived from observations of patients with acquired encephalon lesions. Functional imaging studies have demonstrated that the cognitive processes that emphasize temporal features, such every bit oral communication perception, activate the left hemisphere more the right hemisphere, whereas the opposite blueprint of lateralization has been observed when the emphasis is on spectral or pitch information [half-dozen,7].
As a complement to these two classically defined language areas, it has been proposed that the putative human mirror neuron organisation (MNS) plays an important function in the acquisition of linguistic communication. Originally discovered in area F5 of the macaque monkey, neurons in this region burn in response to both observed and performed actions [viii–10]. A homolog area is believed to exist in the man encephalon with its hub in the junior frontal gyrus, which overlaps with Broca'due south expanse. Other regions, such every bit the inferior parietal lobule and the superior temporal sulcus, are likewise believed to contain mirror neurons [9–11]. The shared representations of observed and executed actions in these neurons may serve every bit a foundation for our capacity to empathise the experiences of other people, which is crucial for constructive communication and social interactions. Accordingly, it has been hypothesized that an intact MNS might underlie normal language functions in humans [12,thirteen], and that linguistic communication comprehension may be achieved through action understanding and mental simulations of sensory motor structures [13–15]. Equally illustrated beneath, components of the putative MNS are often abnormal in individuals with autism, which may account for some of their behavioral deficits, such every bit those related to language [12,13].
Structural abnormalities in autism
Neuroimaging studies reported structural differences in language-related regions between individuals with autism and controls. A larger full encephalon volume has been consistently reported in children with autism [sixteen–19], with some studies showing that this overall volume difference may persist through to machismo [20,21].
Abnormal asymmetry in frontal and temporal areas has been reported by a number of studies, although the direction of regional abnormalities is somewhat inconsistent. For example, a reversal of the usual left–right asymmetry (in typically developing individuals) has been found in the right inferior frontal gyrus, with larger volumes in the correct hemisphere of individuals with autism [22,23]. By dissimilarity, a smaller right book in autism has too been reported [24]. Using structural MRI, smaller volumes of the left planum temporale accept been observed [25,26]. Even so, other enquiry has reported a reduction in both hemispheres [27]. The inconsistent findings reported by these structural imaging studies may be attributable, in part, to the complexity of the disorder, which may have different etiologies, likewise as intrinsic heterogeneity in linguistic abilities among individuals on the autism spectrum. In item, individuals with Asperger's syndrome with no language delay should be separated from individuals with autism who display atypical language development. Indeed, McAlonan et al. plant greyness matter differences between these 2 groups [28]; children with autism had smaller gray matter volumes in posterior cingulate and precuneus regions compared with the Asperger's group. Therefore, this finding highlights the importance of language skills as a differentiating variable.
A contempo written report compared a relatively homogenous group of participants (singular language evolution with average IQ) with matched controls [29]. Increases in cortical thickness were found in the autism grouping in areas that are implicated in social cognition and communication, such as the junior frontal gyrus, superior temporal sulcus, inferior parietal lobule and fusiform gyrus. Thus, it appears that structural abnormalities are apparent in brains of individuals with autism, particularly in areas that underlie core features such as communication bug of the disorder.
Aberrant connectivity in autism
To fully characterize the neural underpinnings of autism, it may be necessary to view information technology equally a disorder of connections betwixt encephalon regions rather than at the level of a single region. From this perspective, the language deficits in autism may be due to problems integrating a set of brain functions into a coherent concept fifty-fifty though the ability to execute individual functions may exist relatively preserved. Indeed, it has been reported that some high-operation children with autism have unusual strengths in processing unmarried words, whereas their ability to process the meaning of complex sentences is significantly dumb [30].
Connectivity across brain regions can be examined using functional and structural imaging techniques. Functional connectivity examines the extent to which the activation levels within specified regions of interest are correlated with each other. Using functional MRI (fMRI), Just et al. compared the activation patterns betwixt high-operation individuals with autism and controls on a written sentence comprehension task [31]. The autism group demonstrated increased activation in Wernicke's surface area but decreased activation in Broca's area. Despite the enhanced activation in Wernicke's expanse, in that location was reduced functional connectivity (less correlation in activeness) across the two areas in the autism group, supporting the idea that language functions may exist poorly integrated in autism.
In addition to functional connectivity, researchers accept as well investigated abnormalities in brain networks using a structural imaging method known every bit diffusion tensor imaging (DTI). DTI enables the delineation of white matter tract structure based on the caste of restriction to water improvidence and the management of water diffusion (fractional anisotropy [FA]). Low FA implies less organized improvidence of water molecules along axons or in a sure direction, which reflects lower white affair integrity and maybe less efficient transmission of information. To date, only a scattering of DTI studies in autism take been conducted, and depression FA has been found in a number of key brain regions; the corpus callosum [32], which is critical for interhemispheric communication; the white matter of the superior temporal gyrus and the temporal stem, which includes portions of the uncinate fasciculus and inferior occipitofrontal fasciculus [32], which are important for linguistic communication and sound processing and comprehension; and the ventromedial prefrontal cortices, the anterior cingulated gyri and the temporoparietal junction [33], which are critical for social cognitive processing. Recent research has likewise reported aberration in the corpus callosum and frontal lobe tracts, such every bit the arcuate fasciculus, in children with autism [34].
In addition to abnormal long-range connectivity across brain regions, researchers suggested that there may be increased short-range connectivity in autism [35,36]. Post-mortem studies reported increased density of cortical minicolumns in brains of individuals with autism, suggesting a greater proportion of brusque range (as opposed to long-range) fibers [36]. Similarly, Herbert and colleagues [35] used a white thing parcellation technique and found increased radiate white matter in the autism grouping, which contains predominately short association fibers. Thus, these findings betoken abnormal microstructure of white matter in autism.
Language-related anatomical pathways
A number of tracts in the human brain are believed to be involved in language and speech processing, and possibly in the integration of auditory and motor functions. They are the arcuate fasciculus (AF), extreme capsule (EmC) and the uncinate fasciculus (UF). The tract that has received the near attention is the AF, which is a bundle of arched fibers that supposedly reciprocally connects the frontal motor coordinating and planning centers with the posterior temporal comprehension and auditory feedback regions. The AF may overlap with parts of the superior longitudinal fascicle [37,38]. Patients with isolated lesion of simply the AF, known as conduction aphasics, accept difficulty with aspects of linguistic communication functions, such every bit poor give-and-take and phrase repetition and issues with naming, but relatively intact spontaneous voice communication and comprehension. The role of the AF can also be inferred from the structural asymmetry of the tracts across the ii hemispheres, which may exist either the cause or the outcome of hemispheric language specialization [39]. Indeed, a number of studies have reported left hemispheric dominance of the AF with a larger volume and a more elaborate connection pattern [38,40,41], which is consistent with its hypothesized function of language processing.
Although there is widespread support for the Broca–Wernicke connection of the AF, recent findings take also implicated the involvement of the precentral gyrus, the premotor and primary motor areas [38,39]. This has led to the suggestion that the AF connects the Broca'due south and Wernicke's area through a relay station located in the premotor and motor cortex [42], which highlights the importance of this auditory-motor feedforward and feedback loop through the AF in coordinating and planning the motor actions of speech communication production, as well equally the monitoring of speech production and language learning [42]. In particular, the connection between the postcentral gyrus and the inferior frontal gyrus may underlie imitation and programming of speech, which is important for linguistic communication acquisition. This idea fits well with the clinical view that speech apraxia may underlie some of the deficits associated with conduction aphasia [42]. More chiefly, the complete absence of voice communication in some individuals with autism, and the voice communication–motor planning difficulties of these individuals observed in our ain laboratory [43], highlights the possible involvement of the AF in accounting for the communication deficits in autism.
Beyond the AF, recent research has implicated two other frontotemporal tracts, the UF and EmC, which may underlie language functions in humans. The UF is a claw-shaped fiber bundle that links the anterior temporal lobe to the orbitofrontal area, including the inferior frontal gyrus [38]. Some of its hypothesized functions include lexical retrieval, semantic associations and naming of deportment [38]. The EmC is a fiber bundle that interconnects the prefrontal cortex/inferior frontal cortex and the superior temporal gyrus extending into the inferior parietal lobule. The EmC has not been studied extensively; yet, it is believed to play a office in language processing and possibly even auditory–motor mapping owing to the cobweb'due south grade connecting parts of both Broca's and Wernicke's areas [44].
Given the connections between frontal and temporal regions, these anatomical pathways may serve to integrate sensory information with motor planning, training and activity areas that is crucial for language representation and operations. Hickok and Poeppel proposed a dual-stream framework in which phonological and semantic processing occurs in ii separate pathways [45]. The dorsal stream, which connects the temporal lobe with the inferior motor/premotor and pIFG via the AF, is responsible for the mapping of audio onto articulatory-based representations. Past dissimilarity, the ventral stream connects the temporal lobe with the anterior junior frontal gyrus and the inferior/ventral prefrontal cortex via the UF and EmC tracts, and is involved in the mapping of audio onto meaning.
The role of some of these anatomical pathways in autism has been recently investigated [34]. Relative to the controls, individuals with autism had a greater number of long fibers in the correct AF and UF. As illustrated in Effigy 1 by our own data, the correct AF and UF of a nonverbal male child (correct) with autism accept more fibers and possibly a different microarchitecture than that of his historic period-matched control (left). We speculate that the reduced left–correct asymmetries and microstructural abnormalities of anatomically identified tracts may be involved in the language deficits associated with autism. Like structural problems have been observed in hippocampo-fusiform and amygdalo-fusiform tracts in their involvement in social and face cognition [46].
Diffusion tensor imaging scans of a healthy 8-twelvemonth-onetime boy (left panel) and an viii-year-old nonverbal boy with autism (right console)
The right arcuate fasciculus (A) and uncinate fasciculus (B) of the nonverbal boy is slighter larger than that of the age-matched control (C & D).
Music making equally a potential intervention to facilitate auditory–motor mapping
How can the aberrant connections in autism be modified? It is well known that the human brain is capable of reorganization in response to ecology demands. Intensive grooming, in particular, has been shown to produce long-lasting functional and structural modifications in the brain. Music making and intensive musical training over long periods of time provide a particularly good opportunity for studying brain plasticity, as it is an intense, multisensory, motor experience that incorporates auditory feedback in improving sensorimotor skills. It has been demonstrated that children who appoint in long-term instrumental practice have larger corpus callosum [47], as well as frontal, temporal and motor areas [48], relative to controls. Similarly, adult patients with Broca's aphasia who engage in an intensive course of music-based speech therapy showed increases in fiber number and volume of the AF [49], the frontal-temporal tract that may underlie the communication deficits in individuals with autism. These structural changes are consistent with a large trunk of literature suggesting preparation-induced plasticity, such as in jugglers [fifty,51], taxi drivers [52] and foreign language learners [53]. A contempo study using DTI too showed structural changes following preparation with a complex visual–motor job [54].
Given the potential benefits of music making in producing plastic changes in the brain, it is conceivable that a music-based intervention can be used to engage and strengthen the connections between frontal and temporal regions that are abnormal in autism, thus potentially enabling affected individuals to develop their language skills. One such intervention is auditory–motor mapping grooming (AMMT) [43], which utilizes the musical strengths of individuals with autism, many of whom exhibit superior music perception abilities [55–57] and thoroughly enjoy music making (through singing and/or playing an instrument) [58–60]. In addition, they tend to focus more on the perceptual (east.g., prosodic) information rather than the linguistic data of speech compared to typically developing individuals, which may contribute to their language and communication deficits [61–65]. Moreover, listening to music tin evoke a great intensity of emotions in individuals with autism, who typically have difficulty processing emotions, a condition known as alexithymia [66–68]. The potential utility of music interventions in autism has been reported [69,70]. Musical stimuli accept been shown to actuate encephalon regions associated with the processing of emotions, such as the insular and cingulate cortex, hypothalamus, hippocampus, amygdala and prefrontal cortex [71], thus further highlighting the therapeutic potential of musical activities in autism.
Auditory–motor mapping training involves three main components: singing, motor activity and faux. This training contains features of MIT [72], merely likewise uses a ready of tuned drums to engage both hands in rhythmic motor activity and to facilitate auditory–motor mapping. Singing (more than than speaking) is known to engage a bilateral reciprocal network between frontal and temporal regions, which incorporate some components of the putative MNS [73,74]. Critically, it has been proposed that a dysfunctional MNS underlies some of the language deficits in autism [75], although some researchers accept argued that the mirror neuron explanation may non account for all of the deficits in autism [76]. Motor action (through playing an instrument) not only captures the child's involvement, but also engages a sensorimotor network that controls orofacial and articulatory movements in oral communication [77]. The sound produced by the instrument may likewise facilitate the auditory–motor mapping that is disquisitional for meaningful song communication [78]. Imitation through repetitive training facilitates learning and alters the responses in the MNS [79].
The potential utility of AMMT in ameliorating the linguistic communication deficits in autism is reinforced by neuroimaging research showing overlapping responses to music and language stimuli [74,80–83]. In detail, fMRI studies take reported activation of the inferior frontal regions during music perception tasks [eighty,84], active music tasks such equally singing [74] and imagining playing an musical instrument [85,86]. Enquiry has also shown that the dopaminergic system plays an important part in some aspects of language processing (e.1000., grammar) [87] and that this system also mediates musical pleasance in individuals with autism [88]. Moreover, a common network appears to support the sensorimotor components for both speaking and singing [74,86,89], and engaging in musical activities has been shown to improve verbal abilities in language-delayed children [xc].
Conclusion
Taken together, therapies that incorporate elements of music making (east.m., AMMT) may offering a viable approach to facilitate social skills and communication – including expressive linguistic communication – in otherwise nonverbal individuals with autism. More importantly, equally evidenced by the literature on training-induced plasticity, an intensive class of music-based or auditory-motor intervention, such equally AMMT, may create a state of affairs in which long-range connections betwixt auditory and motor regions could exist particularly engaged and perhaps strengthened, such as those observed following intensive music preparation in children [47], or melodic intonation therapy in aphasic patients [49]. Given the aberrant connectivity betwixt frontal and temporal regions in autism, and the abnormalities within these 2 regions, the AF, the UF and the EmC may be some of the long-range tracts that serve equally targets for experimental treatments to facilitate advice skills in autism.
Future perspective
Over the by decade, research on autism has focused on its behavioral manifestations, neural underpinning, and more than recently, possible candidate genes. Although the mechanisms underlying autism remain elusive, the considerable torso of inquiry conducted to appointment has laid a foundation for the development of new and innovative interventions. Theoretically grounded music-based interventions have been underutilized, which is unfortunate because music perception and music making is known to exist a relative force of individuals with autism. In particular, no written report has systematically investigated the efficacy of a music-based intervention in facilitating speech output, and whether an intensive program tin induce plastic changes in the brains of these individuals. On the basis of previous and current research, nosotros hope that such specialized treatments for autism will exist developed in the near future. Ultimately, such treatments should maximize the individual'due south potential for developing or relearning expressive language role and, thus, improve the quality of life for people with autism and their families.
Acknowledgments
The authors would like to thank Krystal Demaine, Lauryn Zipse, Rebecca Baars, Andrea Norton, Amanda Libenson, Jenny Zuk and Loes Bazen, for fruitful discussions on music and autism and innovative treatment options for children with exact communications deficits.
The authors would like to thank the Nancy Lurie Marks Family Foundation for their grant support. Gottfried Schlaug too acknowledges support from the NIH (1RO1 DC008796, 3R01DC008796-02S1, R01 DC009823-01).
Footnotes
Financial & competing interests disclosure
The authors have no other relevant affiliations or fiscal involvement with any organization or entity with a financial interest in or financial conflict with the field of study affair or materials discussed in the manuscript apart from those disclosed.
No writing assist was utilized in the production of this manuscript.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3011184/
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