Heffler Karen Frankel, Oestreicher Leonard M
Department of Ophthalmology, Drexel University College of Medicine, Philadelphia, PA USA.
Society for the Study of ASD & Social-Communication, Merced, California USA.
Med Hypotheses. 2016 Jun;91:114-122. doi: 10.1016/j.mehy.2015.06.019. Epub 2015 Jun 27.
Earliest identifiable findings in autism indicate that the autistic brain develops differently from the typical brain in the first year of life, after a period of typical development. Twin studies suggest that autism has an environmental component contributing to causation. Increased availability of audiovisual (AV) materials and viewing practices of infants parallel the time frame of the rise in prevalence of autism spectrum disorder (ASD). Studies have shown an association between ASD and increased TV/cable screen exposure in infancy, suggesting AV exposure in infancy as a possible contributing cause of ASD. Infants are attracted to the saliency of AV materials, yet do not have the experience to recognize these stimuli as socially relevant. The authors present a developmental model of autism in which exposure to screen-based AV input in genetically susceptible infants stimulates specialization of non-social sensory processing in the brain. Through a process of neuroplasticity, the autistic infant develops the skills that are driven by the AV viewing. The AV developed neuronal pathways compete with preference for social processing, negatively affecting development of social brain pathways and causing global developmental delay. This model explains atypical face and speech processing, as well as preference for AV synchrony over biological motion in ASD. Neural hyper-connectivity, enlarged brain size and special abilities in visual, auditory and motion processing in ASD are also explained by the model. Positive effects of early intervention are predicted by the model. Researchers studying causation of autism have largely overlooked AV exposure in infancy as a potential contributing factor. The authors call for increased public awareness of the association between early screen viewing and ASD, and a concerted research effort to determine the extent of causal relationship.
自闭症最早可识别的表现表明,在经历一段正常发育时期后,自闭症患儿的大脑在出生后的第一年里发育方式与正常大脑不同。双胞胎研究表明,自闭症有环境因素参与致病。视听材料的可获得性增加以及婴儿的观看习惯与自闭症谱系障碍(ASD)患病率上升的时间框架相平行。研究表明,ASD与婴儿期电视/有线电视屏幕暴露增加之间存在关联,这表明婴儿期的视听暴露可能是ASD的一个促成原因。婴儿被视听材料的显著性所吸引,但没有经验将这些刺激识别为与社交相关。作者提出了一个自闭症发展模型,在该模型中,基因易感婴儿接触基于屏幕的视听输入会刺激大脑中非社交感官处理的专门化。通过神经可塑性过程,自闭症婴儿发展出由观看视听内容所驱动的技能。由此发展出的视听神经元通路与社交处理偏好相互竞争,对社交脑通路的发育产生负面影响,并导致整体发育迟缓。该模型解释了ASD中面部和言语处理的异常,以及对视听同步而非生物运动的偏好。该模型还解释了ASD中的神经超连接、大脑体积增大以及视觉、听觉和运动处理方面的特殊能力。该模型预测了早期干预的积极效果。研究自闭症病因的研究人员在很大程度上忽略了婴儿期的视听暴露这一潜在促成因素。作者呼吁提高公众对早期屏幕观看与ASD之间关联的认识,并开展协同研究以确定因果关系的程度。