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PUBLIC RELEASE DATE:
17-Jun-2013

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Contact: Erin Digitale
digitale@stanford.edu
650-724-9175
Stanford University Medical Center
@sumedicine

Voices may not trigger brain's reward centers in children with autism, Stanford/Packard study shows

STANFORD, Calif. - In autism, brain regions tailored to respond to voices are poorly connected to reward-processing circuits, according to a new study by scientists at the Stanford University School of Medicine.

The research could help explain why children with autism struggle to grasp the social and emotional aspects of human speech. "Weak brain connectivity may impede children with autism from experiencing speech as pleasurable," said Vinod Menon, PhD, senior author of the study, which will be published online June 17 in Proceedings of the National Academy of Sciences. Menon is a professor of psychiatry and behavioral sciences at Stanford and a member of the Child Health Research Institute at Lucile Packard Children's Hospital.

"The human voice is a very important sound; it not only conveys meaning but also provides critical emotional information to a child," said Daniel Abrams, PhD, a postdoctoral scholar in psychiatry and behavioral sciences who was the study's lead author. Insensitivity to the human voice is a hallmark of autism, Abrams said, adding, "We are the first to show that this insensitivity may originate from impaired reward circuitry in the brain."

The study focused on children with a high-functioning form of autism. They had IQ scores in the normal range and could speak and read, but had difficulty holding a back-and-forth conversation or understanding emotional cues in another person's voice.

The scientists compared functional magnetic resonance imaging brain scans from 20 of these children with scans from 19 typically developing children, paying particular attention to a portion of the brain that responds selectively to the sound of human voices. Prior research has shown that adults with autism had low voice-selective cortex activity in response to speech. But until this study by Menon and his colleagues, no one had looked at connections between the voice-selective cortex and other brain regions in individuals with autism.

The new study found that in children with a high-functioning form of autism, the voice-selective cortex on the left side of the brain was weakly connected to the nucleus accumbens and the ventral tegmental area - brain structures that release dopamine in response to rewards. The voice-selective cortex on the right side of the brain, which specializes in detecting vocal cues such as intonation and pitch, was weakly connected to the amygdala, which processes emotional cues.

The weaker these connections in children with autism, the worse their communication deficits, the study showed. The researchers were able to predict the children's scores on the verbal portion of a standard test of autism severity by looking at the degree of impairment in these brain connections.

The findings may help to validate some autism therapies already in use, said co-author Jennifer Phillips, PhD, a clinical associate professor of psychiatry and behavioral sciences at Stanford who also treats children with autism at Packard Children's. For instance, pivotal-response training aims to increase social use of language in children who can speak some words but who usually do not talk to others.

"Pivotal-response training goes after ways to naturally motivate kids to start using language and other forms of social interaction," Phillips said. Future studies could test whether brain connections leading from voice to reward centers are strengthened by autism therapies, she added.

The findings also help resolve a long-standing debate about why individuals with autism show less-than-normal interest in human voices. The team investigated two competing theories to explain the phenomenon: that individuals with autism have a deficit in their social motivation, or, alternatively, that they have sensory-processing deficits which impair their ability to fully hear human voices. The new study found normal connections between voice-selective cortex and primary auditory brain regions in children with high-functioning autism, suggesting that these children do not have sensory-processing deficits.

The next steps for researchers include studying the consequences of the weak voice-to-reward circuit in autism. "It is likely that children with autism don't attend to voices because they are not rewarding or emotionally interesting, impacting the development of their language and social communication skills," Menon said. "We have discovered an aberrant brain circuit underlying a core deficit in autism; our findings may aid the development of new treatments for this disorder."

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Other Stanford co-authors are social science research assistants Charles Lynch and Katherine Cheng; postdoctoral scholar Kaustubh Supekar, PhD; research associate Srikanth Ryali, PhD; and instructor Lucina Uddin, PhD.

The work was funded by the National Institutes of Health (National Research Service award F32DC010322, NIH Career Development award K01MH092288, and grants DC011095 and MH084164), as well as grants from the Singer Foundation and the Stanford Institute for Neuro-Innovation & Translational Neurosciences.

Information about Stanford's Department of Psychiatry and Behavioral Sciences, which also supported the work, is available at http://psychiatry.stanford.edu.

The Stanford University School of Medicine consistently ranks among the nation's top medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children's Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Lucile Packard Children's Hospital at Stanford is an internationally recognized 311-bed hospital, research center and leading regional medical network providing a full complement of services for the health of children and expectant mothers. In partnership with the Stanford University School of Medicine, our world-class doctors and nurses deliver innovative, family-centered care in every pediatric and obstetric specialty. Packard Children's is annually ranked as one of the nation's finest by U.S. News & World Report and the only Northern California children's hospital with specialty programs ranked in the U.S. News Top 10. Learn more about the Packard Children's Health Alliance at PCHA.org; explore our hospital expansion at growing.lpch.org; and find our full range of pre-eminent programs at lpch.org. Like us on Facebook, watch us on YouTube and follow us on Twitter.

Print media contact: Erin Digitale at (650) 724-9175 (digitale@stanford.edu)
Broadcast media contact: M.A. Malone at (650) 723-6912 (mamalone@stanford.edu)



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