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Autism Awareness Night Understanding Causes Treatments of ASD In the Next 25 Years Nancy Minshew MD Professor of Psychiatry Neurology Director NIH Autism Center of Excellence April 1 2010 Progress Comes From Participation We wish to honor those individuals and families who have believed in research and been committed to participating again and again ASD Behaviorally Defined Syndromes 3 Core Symptoms Associated Symptoms sensory motor Co morbid Conditions intellectual disability ADHD seizures regulation disorders Behaviorally Based Autism Theories Dominated the 20th Century Social impairment pathognomonic inferred to be the cause of syndrome social primacy Alternative No unifying core deficits found each independent dimensional approach genes independent Pitfall expectation that human behavior predicts brain function failure to seek out neurological mechanisms principles that govern presentation expression of neurodevelopmental disorders Developmental Neurobiologic Events Organogenesis Neuronal proliferation Glial proliferation migration Neuronal migration Neuronal organization Myelination Organization How the Brain Develops 15 1 2 wks 27 weeks 22 wks 23 wks Full term brain 25 wks Adult 2 43 Camera Lucida composite drawings of neurons in the visual calcarine cortex of human infants indicated gestational ages Note the appearance and elaboration of basilar dendrites and the tangential spread of apical dendrites as well as the accompanying maturation of the visual evoked response top Courtesy of Dr Dominick Purpura How the Brain Develops Clues To Underlying Brain Events in Autism Age of onset Selective involvement of higher cortical functions Golgi stain truncated dendritic tree development Whole brain too big HC weights total volume Cortical Under connectivity Reliably lower functional connectivity for autism participants between pairs of key areas during sentence comprehension red end of scale denotes lower connectivity Reliable differences in functional connectivity

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