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胼胝体发育不全与自闭症:全面比较。

Agenesis of the corpus callosum and autism: a comprehensive comparison.

机构信息

1 California Institute of Technology, Division of Humanities and Social Sciences, Pasadena, CA, USA

2 Rady Children's Hospital, San Diego, CA, USA.

出版信息

Brain. 2014 Jun;137(Pt 6):1813-29. doi: 10.1093/brain/awu070. Epub 2014 Apr 25.

Abstract

The corpus callosum, with its ∼200 million axons, remains enigmatic in its contribution to cognition and behaviour. Agenesis of the corpus callosum is a congenital condition in which the corpus callosum fails to develop; such individuals exhibit localized deficits in non-literal language comprehension, humour, theory of mind and social reasoning. These findings together with parent reports suggest that behavioural and cognitive impairments in subjects with callosal agenesis may overlap with the profile of autism spectrum disorders, particularly with respect to impairments in social interaction and communication. To provide a comprehensive test of this hypothesis, we directly compared a group of 26 adults with callosal agenesis to a group of 28 adults with a diagnosis of autism spectrum disorder but no neurological abnormality. All participants had full-scale intelligence quotient scores >78 and groups were matched on age, handedness, and gender ratio. Using the Autism Diagnostic Observation Schedule together with current clinical presentation to assess autistic symptomatology, we found that 8/26 (about a third) of agenesis subjects presented with autism. However, more formal diagnosis additionally involving recollective parent-report measures regarding childhood behaviour showed that only 3/22 met complete formal criteria for an autism spectrum disorder (parent reports were unavailable for four subjects). We found no relationship between intelligence quotient and autism symptomatology in callosal agenesis, nor evidence that the presence of any residual corpus callosum differentiated those who exhibited current autism spectrum symptoms from those who did not. Relative to the autism spectrum comparison group, parent ratings of childhood behaviour indicated children with agenesis were less likely to meet diagnostic criteria for autism, even for those who met autism spectrum criteria as adults, and even though there was no group difference in parent report of current behaviours. The findings suggest two broad conclusions. First, they support the hypothesis that congenital disruption of the corpus callosum constitutes a major risk factor for developing autism. Second, they quantify specific features that distinguish autistic behaviour associated with callosal agenesis from autism more generally. Taken together, these two findings also leverage specific questions for future investigation: what are the distal causes (genetic and environmental) determining both callosal agenesis and its autistic features, and what are the proximal mechanisms by which absence of the callosum might generate autistic symptomatology?

摘要

胼胝体,拥有约 2 亿个轴突,在其对认知和行为的贡献方面仍然是一个谜。胼胝体发育不全是一种先天性疾病,其中胼胝体未能发育;这样的个体在非字面语言理解、幽默、心理理论和社会推理方面表现出局部缺陷。这些发现以及家长报告表明,胼胝体发育不全患者的行为和认知障碍可能与自闭症谱系障碍的特征重叠,特别是在社交互动和沟通方面的障碍。为了全面检验这一假设,我们直接比较了 26 名胼胝体发育不全患者和 28 名自闭症谱系障碍但无神经异常的患者。所有参与者的智力测试分数均大于 78,并且年龄、惯用手和性别比例匹配。我们使用自闭症诊断观察量表结合当前的临床表现来评估自闭症症状,发现 26 名发育不全患者中有 8 名(约三分之一)患有自闭症。然而,更正式的诊断还涉及对儿童行为的回忆性家长报告测量,结果表明只有 3/22 名患者完全符合自闭症谱系障碍的正式标准(有 4 名患者的家长报告不可用)。我们发现胼胝体发育不全患者的智商与自闭症症状之间没有关系,也没有证据表明任何残余胼胝体可以区分那些表现出当前自闭症谱系症状的人和那些没有的人。与自闭症谱系比较组相比,家长对儿童行为的评价表明,即使对于那些成年后符合自闭症谱系标准的人,发育不全的儿童也不太可能符合自闭症的诊断标准,即使他们的当前行为的家长报告没有组间差异。这些发现得出了两个广泛的结论。首先,它们支持了这样的假设,即胼胝体的先天性破坏构成了发展自闭症的主要危险因素。其次,它们量化了将与胼胝体发育不全相关的自闭症行为与更广泛的自闭症区分开来的具体特征。总的来说,这两个发现也为未来的研究提出了具体的问题:是什么导致胼胝体发育不全和其自闭症特征的远端原因(遗传和环境),以及胼胝体缺失如何产生自闭症症状的近端机制?

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