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Autism Diagnosis Differentiates Neurophysiological Responses To Tye et al. Journal of Neurodevelopmental Disorders (2015) 7:33 DOI 10.1186/s11689-015-9129-2 RESEARCH Open Access Autism diagnosis differentiates neurophysiological responses to faces in adults with tuberous sclerosis complex Charlotte Tye1,2*, Teresa Farroni3,4, Ágnes Volein4, Evelyne Mercure5, Leslie Tucker4, Mark H. Johnson4 and Patrick F. Bolton1,2 Abstract Background: Autism spectrum disorder (ASD) is a common and highly heritable neurodevelopmental disorder that is likely to be the outcome of complex aetiological mechanisms. One strategy to provide insight is to study ASD within tuberous sclerosis complex (TSC), a rare disorder with a high incidence of ASD, but for which the genetic cause is determined. Individuals with ASD consistently demonstrate face processing impairments, but these have not been examined in adults with TSC using event-related potentials (ERPs) that are able to capture distinct temporal stages of processing. Methods: For adults with TSC (n = 14), 6 of which had a diagnosis of ASD, and control adults (n = 13) passively viewed upright and inverted human faces with direct or averted gaze, with concurrent EEG recording. Amplitude and latency of the P1 and N170 ERPs were measured. Results: Individuals with TSC + ASD exhibited longer N170 latencies to faces compared to typical adults. Typical adults and adults with TSC-only exhibited longer N170 latency to inverted versus upright faces, whereas individuals with TSC + ASD did not show latency differences according to face orientation. In addition, individuals with TSC + ASD showed increased N170 latency to averted compared to direct gaze, which was not demonstrated in typical adults. A reduced lateralization was shown for the TSC + ASD groups on P1 and N170 amplitude. Conclusions: The findings suggest that individuals with TSC + ASD may have similar electrophysiological abnormalities to idiopathic ASD and are suggestive of developmental delay. Identifying brain-based markers of ASD that are similar in TSC and idiopathic cases is likely to help elucidate the risk pathways to ASD. Keywords: Autism spectrum disorder, ERP, Face, Gaze, Tuberous sclerosis complex Background genetic risk in a substantial minority of cases [4, 5]. Autism spectrum disorder (ASD) is a common childhood- Genome-wide association studies indicate that other more onset disorder characterized by social and communication common variants likely play a role, but the studies re- impairments and restricted/repetitive behaviours and in- ported to date are underpowered to confidently identify terests. Family and twin studies indicate that genetic fac- the major variants involved [6, 7]. Nevertheless, the find- tors play an important role in the aetiology of ASD, but ings to date are helping to identify putative neurobio- non-genetic factors are also likely to be relevant in caus- logical processes involved in aetiology, with a major focus ation [1–3]. Molecular genetic studies have identified a on the genes involved in synaptic development and func- number of copy numbers and rare variants that underlie tion [8]. Neuroimaging studies have also begun to chart the structural and functional correlates of ASD, * Correspondence: [email protected] but findings have been rather inconsistent, possibly 1 MRC Social, Genetic and Developmental Psychiatry Centre, Institute of reflecting clinical and underlying genetic heterogen- Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK 2Child and Adolescent Psychiatry, Institute of Psychiatry, King’s College eity. One strategy to address the problem of genetic het- London, London, UK erogeneity is to study syndromic model systems of ASD Full list of author information is available at the end of the article © 2015 Tye et al. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Tye et al. Journal of Neurodevelopmental Disorders (2015) 7:33 Page 2 of 9 where the genetic cause is constrained. Tuberous sclerosis the disorder such as impaired eye contact, joint attention complex (TSC) is a multi-systemic disorder caused by a and theory of mind, which suggests it is a key brain-based mutation in TSC1 on chromosome 9q34 or TSC2 on biomarker of risk for ASD. chromosome 16p13.3. Individuals with mutations in the Given that previous findings suggest an association TSC genes develop a variable and diverse array of physical, between the presence of tubers in the temporal regions cognitive and behavioural manifestations [9]. Remarkable associated with face processing and risk of ASD in TSC progress has been made with regard to clarifying the mo- [40], there is relatively little work examining whether the lecular biology of TSC, and this has led to extremely same neurophysiological correlates of impaired face pro- promising new treatment approaches [10–12]. cessing operate in syndromic ASD. A study of young Several studies have shown that autistic behaviours children with TSC reported delayed N290 (the develop- are frequently observed [13, 14], and between 30 and mental ‘precursor’ to the N170) and reduced lateralization, 60 % of individuals with TSC meet diagnostic criteria effects that were particularly pronounced in children with for ASD [9, 15–17]. It is likely, therefore, that there a diagnosis of ASD [41]. There has not, however, been an are specific risk mechanisms that determine which in- investigation of electrophysiological responses to changes dividuals develop ASD [18]. To shed light on the gene- in face orientation and gaze direction in adults with TSC. brain-behaviour risk pathways, an important approach is The current study aimed to examine neurophysio- to examine brain-based candidate biomarkers. In particu- logical responses to faces and eye gaze in adults with lar, event-related potentials (ERPs) are able to capture fast- TSC with and without a diagnosis of ASD, compared to occurring altered cognitive processes in individuals of typical adult controls, using a paradigm that has been different ages and abilities and thus are suitable for identi- used in several previous studies of ASD [21, 35, 42, 43]. fying biomarkers of complex neurodevelopmental disor- On the basis of previous work, it was hypothesized that ders [19–23]. In order to identify these risk factors, it is neurophysiological responses to faces would differ in important to demonstrate that syndromic ASD (occurring TSC + ASD compared to controls. Specifically, we pre- within a syndrome such as TSC) is the same as idiopathic dicted that adults with TSC + ASD would show (1) slo- ASD, by examining a domain that is known to be altered wed processing of faces, (2) a reduced effect of face in the latter. A strong candidate biomarker of ASD is im- orientation and (3) altered processing of gaze direction. pairment in the ability to process information from the face, associated with activity in temporal brain regions. Methods Findings from ERP studies indicate abnormal responses to Participants face stimuli in ASD, notably a delayed ‘face-sensitive’ N170 Typical control adults (n =13,male n = 11) and adults [24], a reduction or absence of the face inversion effect on with TSC (n = 14, male n = 9) were recruited for the the visual P1 and N170 amplitude [24–34] and altered pro- study. Participants with TSC underwent a multidiscip- cessing of gaze direction on the N170 [21, 35, 36]. Abnor- linary clinical assessment, and six participants (male mal ERP responses to gaze direction are also observed in n = 5) were given a clinical diagnosis of ASD accord- infant siblings of children with ASD [37, 38] and are pre- ing to DSM-IV criteria. Participants were aged 16– dictive of subsequent ASD diagnosis [37]. In addition, 46 years (mean age = 26.85, SD = 7.29); there were no while the N170 is larger in the right hemiscalp compared significant differences in age or gender proportions to the left hemiscalp in typically developing individuals, in- between groups (Table 1). Intellectual ability was dividuals with autism show an atypical bilateral scalp distri- measured using different tools depending on the abil- bution [24, 29, 36, 39] suggestive of abnormal cortical ity level of the participant (Vineland Adaptive Behav- specialization for faces [27]. Altered processing of faces iour Scales, Wechsler Intelligence Scale for Children, may contribute to the social impairments characterizing Wechsler Adult Intelligence Scale, Raven’s matrices, Table 1 Demographic and clinical characteristics Controls TSC TSC + ASD Age (SD) 29.77 (5.67) 25.50 (8.52) 22.33 (6.92) n.s.d. Gender (male, %) 85 50 83 n.s.d. IQ (SD) All >70 88.29 (13.64) 53.33 (30.82) F = 7.40, p = .02 Current epilepsy n/a 25 % 50 % n.s.d Epilepsy severity (SD) n/a 1.43 (3.77) 3.75 (2.87) n.s.d. Epilepsy medication n/a 25 % 100 % x2 = 7.88, p = .01 Abbreviations: n/a not applicable, n.s.d. non-significant difference Tye et al. Journal of Neurodevelopmental Disorders (2015) 7:33 Page 3 of 9 British Picture Vocabulary Scale), and a proxy IQ com- recording. This paradigm has been used previously in bining these measures was created for 13 of the TSC ASD and infant samples [21, 35, 42]. participants (data missing on one participant), similar to previous work in TSC [44]. There was a significant dif- EEG recording and processing ference between TSC-only and ASD groups in intellec- Electroencephalography was recorded using a Hydrocel tual ability measured using this parameter, driven by in control adults and the Geodesic Sensor Net in adults two ASD participants with severe intellectual disability with TSC, each with 128 electrodes (Electrical Geode- (ID) (IQ 20–26).
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