Abstract
Objective: This pilot study aims to identify white matter (WM) tract abnormalities in Autism Spectrum Disorders (ASD) toddlers and pre-schoolers by Diffusion Tensor Imaging (DTI), and to correlate imaging findings with clinical improvement after early interventional and Applied Behavior Analysis (ABA) therapies by Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP).Methods: DTI scans were performed on 17 ASD toddlers/pre-schoolers and seven age-matched controls. Nine ASD patients had follow-up MRI 12 months following early intervention and ABA therapy. VB-MAPP was assessed and compared at diagnosis, 6 and 12 months after therapies. Tract-Based Spatial Statistics (TBSS) was used to measure fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial (RD) diffusivity.Results: VB-MAPP scores improved at 6 and 12 months after early intervention and ABA therapy compared to scores at baseline. TBSS analysis showed significant FA decrease and/or RD increase in ASD patients before therapy vs. controls in inferior fronto-occipital fasciculi, uncinate fasciculi, left superior fronto-occipital fasciculus, forceps minor, left superior fronto-occipital fasciculus, right superior longitudinal fasciculus, corona radiate bilaterally, and left external capsule. A significantly FA increase in 21 tracts and ROIs is reported in post- vs. pre-therapy DTI analysis.Conclusion: DTI findings highlighted ASD patient WM abnormalities at diagnosis and confirmed the benefits of 12 months of early intervention and ABA therapy on clinical and neuro imaging outcomes.
Highlights
Autism spectrum disorders (ASD)are neurodevelopmental disorders characterized by repetitive and restrictive behaviors, and language and socialization deficits in early childhood [1]
This study examines WM differences in ASD using DTI, which enables quantitation of WM maturation in toddlers and preschoolers and depicts axonal abnormalities providing symptom interpretation in ASD
The significant difference between the ASD patients at baseline and neurotypical controls may explain the delay in neural connectivity between various brain regions, which in turn contributes to emotional lability, restricted social communication, language delay, and other symptoms observed in ASD
Summary
Autism spectrum disorders (ASD)are neurodevelopmental disorders characterized by repetitive and restrictive behaviors, and language and socialization deficits in early childhood [1]. Increased parent/physician awareness coupled with improved assessment tools, lead to better diagnosis, and higher prevalence [1/40 children in the United States [2] and. Parents typically have concerns in the first year of life, but diagnosis of ASD is made between the ages of 18–24 months. An abnormal developmental trajectory of the brain [5], early brain development and changes in gray and WM structures and connectivity are associated with emergence of symptoms [6]. WM tracts structural integrity and change in myelination contribute to the pathogenesis of ASD shown in several agegroups [7, 8]. In addition to lack of knowledge regarding myelination in toddlers with ASD, contradictions abound in the literature as to which specific areas are implicated
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