Abstract
The level of functioning of individuals with autism spectrum disorder (ASD) varies widely. To better understand the neurobiological mechanism associated with high-functioning ASD, we studied the rare case of a female patient with an exceptional professional career in the highly competitive academic field of Mathematics. According to the Research Domain Criteria (RDoC) approach, which proposes to describe the basic dimensions of functioning by integrating different levels of information, we conducted four fMRI experiments targeting the (1) social processes domain (Theory of mind (ToM) and face matching), (2) positive valence domain (reward processing), and (3) cognitive domain (N-back). Patient’s data were compared to data of 14 healthy controls (HC). Additionally, we assessed the subjective experience of our case during the experiments. The patient showed increased response times during face matching and achieved a higher total gain in the Reward task, whereas her performance in N-back and ToM was similar to HC. Her brain function differed mainly in the positive valence and cognitive domains. During reward processing, she showed reduced activity in a left-hemispheric frontal network and cortical midline structures but increased connectivity within this network. During the working memory task patients’ brain activity and connectivity in left-hemispheric temporo-frontal regions were elevated. In the ToM task, activity in posterior cingulate cortex and temporo-parietal junction was reduced. We suggest that the high level of functioning in our patient is rather related to the effects in brain connectivity than to local cortical information processing and that subjective report provides a fruitful framework for interpretation.
Highlights
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized in the DSM-5 as a condition with impairments in social interactions and communication as well as the presence of restricted interests and behaviours (American Psychiatric Association 2013)
Deficits in social cognition in persons with ASD have mainly been associated with reduced activation of the medial prefrontal cortex, the temporo-parietal junction (TPJ), the temporal poles as well as the amygdala (Castelli et al 2002; for a review see Dichter 2012). These findings suggest that behavioural alterations in ASD are associated with distinguishable neural dimensions in accordance with the Research Domain Criteria (RDoC) approach
A comparison of personality scales revealed a distinction between the case patient and the control group in the NEO Five-Factor Inventory
Summary
Autism spectrum disorder (ASD) is a pervasive developmental disorder characterized in the DSM-5 as a condition with impairments in social interactions and communication as well as the presence of restricted interests and behaviours (American Psychiatric Association 2013). Reports about remarkable cognitive and perceptual strengths in ASD are not uncommon (Mottron et al 2006; Wheelwright et al 2006; Baron-Cohen et al 2009; Vital et al 2009; e.g., Assouline et al 2012; Gonzalez et al 2013), the ability of patients to use these strengths for a successful career is rare (e.g., Hendricks and Wehman 2009; Kirchner and Dziobek 2014) Given this patient’s extraordinary academic success, in addition to investigating mental domains commonly impaired in ASD, we examined potentially supporting cognitive and affective factors with regard to compensatory effects (Livingston and Happé 2017). While ASD-related impairments within these domains have been intensely investigated on a behavioural level, our knowledge about underlying neural processes is limited to date (e.g., Yamada et al 2012; Rosenblau et al 2016; Watanabe and Rees 2017; BaronCohen and Lombardo 2017)
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