Medical Research: What is the background for this study? What are the main findings?
Dr. Dichter: The background for this study is that although most brain imaging research in autism spectrum disorders has focused on understanding the brain basis of social communication impairments, we know that autism symptoms are pervasive and may include difficulties with irritability, anxiety, mood, and even in some instances aggression or self injurious behaviors. Additionally, these types of associated features are among the first that prompt parents to bring their child to a pediatrician for an evaluation for a neurodevelopmental disorder, and so we know these symptoms can be deeply troubling to parents. All of these associated symptoms of autism suggest difficulty with regulating emotional responses, and so our team set out to investigate the brain basis of these difficulties. We taught participants with and without autism simple strategies to change their emotion responses and then scanned them using functional MRI to measure brain activity when they actively tried to change their emotional responses to pictures of faces. Our central finding was that although they reported they were able to change their emotional responses, brain imaging findings told us something quite different. The dorsolateral prefrontal cortex, a part of the brain that controls emotional responses, was underactive in the participants with autism. Consequently, they were less able to modulate parts of the brain’s limbic system that produces strong emotional responses. In other words, they had difficulty “turning on the brakes” to control emotional responses. Finally, the differences we observed in their brain activity predicted the severity of their overall autism symptoms, suggestion a direct linkage between emotion regulation impairments and autism severity.
Medical Research: What should clinicians and patients take away from your report?
Dr. Dichter: Clinicians are already aware that irritability, anxiety, and mood disturbance are commonly observed in autism, and this study provides an explanation of the brain basis of these associated symptoms. Our finding that overall autism severity is inherently connected to emotion regulation impairments suggests that early behavioral treatments for autism should focus not only of difficulties with social communication, but also on emotion regulation abilities as well.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Dichter: The “glass half full” finding from this work is that we were able to teach high functioning young adults with autism how to implement emotion regulation strategies in the brain scanner, and so these skills are not too abstract or difficult for most high functioning young adults with autism to learn. It thus remains to be seen whether the brain differences we observed are etiologically related to autism or rather a manifestation of a lifetime of underuse. We would like to use this type of paradigm to measure brain responses in younger children with autism before and after a psychosocial treatment designed to improve emotion regulation to see if we can rescue function in these brain regions that are critical for regulating emotional responses.
Neural Mechanisms of Emotion Regulation in Autism Spectrum Disorder
J. Anthony Richey, Cara R. Damiano, Antoinette Sabatino, Alison Rittenberg, Chris Petty, Josh Bizzell, James Voyvodic, Aaron S. Heller, Marika C. Coffman,Moria Smoski,Richard J. Davidson, Gabriel S. Dichter J. Anthony Richey, Cara R. Damiano, Antoinette Sabatino, Alison Rittenberg, Chris Petty,Josh Bizzell,James Voyvodic,Aaron S. Heller,Marika C. Coffman,Moria Smoski,Richard J. Davidson,Gabriel S. Dichter
Journal of Autism and Developmental Disorders January 2015