Ataxia Laboratory, IRCCS Santa Lucia Foundation, Rome, Italy.
Department of Psychology, Sapienza University of Rome, Rome, Italy.
Autism Res. 2021 Nov;14(11):2300-2313. doi: 10.1002/aur.2593. Epub 2021 Aug 10.
In recent years, structural and functional alterations in the cerebellum have been reported in autism spectrum disorder (ASD). Intriguingly, recent studies demonstrated that the social behavioral profile of individuals with cerebellar pathologies is characterized by a theory of mind (ToM) impairment, one of the main behavioral hallmarks of ASD. The aim of the present study was to compare ToM abilities and underlying cerebello-cortical structural patterns between ASD individuals and individuals with cerebellar atrophy to further specify the cerebellar role in mentalizing alterations in ASD. Twenty-one adults with ASD without language and intellectual impairments (based on DSM-5), 36 individuals affected by degenerative cerebellar damage (CB), and 67 healthy participants were enrolled in the study. ToM abilities were assessed using the reading the mind in the eyes test and the faux pas test. One-way ANCOVA was conducted to compare the performances between the two cohorts. Three-dimensional T1-weighted magnetic resonance scans were collected, and a voxel-based morphometry analysis was performed to characterize the brain structural alterations in the two cohorts. ASD and CB participants had comparable ToM performance with similar difficulties in both the tests. CB and ASD participants showed an overlapping pattern of gray matter (GM) reduction in a specific cerebellar portion (Crus-II). Our study provides the first direct comparison of ToM abilities between ASD and CB individuals, boosting the idea that specific cerebellar structural alterations impact the mentalizing process. The present findings open a new perspective for considering the cerebellum as a potential target for treatment implementation. The present work will critically advance current knowledge about the cerebellar role in ToM alterations of ASD, in particular, elucidating the presence of common cerebellar structural abnormalities in ASD and cerebellar individuals that may underlie specific mentalizing alterations. These findings may pave the way for alternative therapeutic indications, such as cerebellar neuromodulation, with a strong clinical impact. LAY SUMMARY: The present work will critically advance current knowledge about the cerebellar role in theory of mind alterations of autism spectrum disorder (ASD), in particular, elucidating the presence of common cerebellar structural abnormalities in ASD and cerebellar individuals that may underlie specific mentalizing alterations. These findings may pave the way for alternative therapeutic indications, such as cerebellar neuromodulation, with a strong clinical impact.
近年来，自闭症谱系障碍（ASD）患者的小脑结构和功能改变已被报道。有趣的是，最近的研究表明，小脑病变患者的社会行为特征表现为心理理论（ToM）损伤，这是 ASD 的主要行为特征之一。本研究的目的是比较 ASD 个体和小脑萎缩个体的 ToM 能力和潜在的小脑皮质结构模式，以进一步明确小脑在 ASD 心理化改变中的作用。研究纳入了 21 名无语言和智力障碍的 ASD 成年人（基于 DSM-5）、36 名患有退行性小脑损伤（CB）的个体和 67 名健康参与者。使用“读心测试”和“失态测试”评估 ToM 能力。采用单因素方差分析比较两组间的表现。采集三维 T1 加权磁共振扫描数据，采用基于体素的形态学分析比较两组的脑结构改变。ASD 和 CB 组的 ToM 表现相当，在两项测试中都有类似的困难。CB 和 ASD 组在小脑特定区域（Crus-II）的灰质（GM）减少存在重叠模式。本研究首次直接比较了 ASD 和 CB 个体的 ToM 能力，这一结果支持特定的小脑结构改变影响心理化过程的观点。目前的研究结果为将小脑视为治疗靶点提供了新的视角。本研究将批判性地推进目前关于小脑在 ASD 心理化改变中的作用的知识，特别是阐明 ASD 和小脑个体中存在共同的小脑结构异常，这可能是特定心理化改变的基础。这些发现可能为小脑神经调节等替代治疗方法铺平道路，具有强烈的临床意义。
