Abstract
Autism spectrum disorders (ASD) have long-term implications on functioning at multiple levels. In this perspective, we offer a brainstem-informed autism framework (BIAF) that traces the protracted neurobehavioral manifestations of ASD to early life brainstem dysfunctions. Early life brainstem-mediated markers involving functions of autonomic/arousal regulation, sleep-wake homeostasis, and sensorimotor integration are delineated. Their possible contributions to the early identification of susceptible infants are discussed. We suggest that the BIAF expands our multidimensional understanding of ASD by focusing on the early involvement of brainstem systems. Importantly, we propose an integrated BIAF screener that brings about the prospect of a sensitive and reliable early life diagnostic scheme for weighing the risk for ASD. The BIAF screener could provide clinicians substantial gains in the future and may carve customized interventions long before the current DSM ASD phenotype is manifested using dyadic co-regulation of brainstem-informed autism markers.
Highlights
The brainstem and its rostral networks underlie a wide array of operations, ranging from autonomic functions such as respiration (Bianchi and Gestreau, 2009), cardiovascular activity (Dampney, 2016), and sleep-wake regulation (Scammell et al, 2017), through sensorimotor reactivity (Kobayashi and Isa, 2002), and even involvement in consciousness and self-awareness (Parvizi and Damasio, 2001).Autism spectrum disorders (ASD) are a set of neurodevelopmental disorders manifested in deficits in social-communication abilities and restrictive and repetitive behaviors (American Psychiatric Association [APA], 2013)
We suggest that brainstem circuits that mature in very early life and even during fetal stages to regulate vital autonomic functions (Zec and Kinney, 2003), have a central role in shaping social communication and adaptation of behavior
We suggest that given the early maturation of brainstem pathways, their pervasive role in functioning at multiple levels, and their specific involvement in social-communication deficits, brainstem functions enable a valuable window into the pathophysiology of ASD
Summary
The brainstem and its rostral networks underlie a wide array of operations, ranging from autonomic functions such as respiration (Bianchi and Gestreau, 2009), cardiovascular activity (Dampney, 2016), and sleep-wake regulation (Scammell et al, 2017), through sensorimotor reactivity (Kobayashi and Isa, 2002), and even involvement in consciousness and self-awareness (Parvizi and Damasio, 2001). Some from our lab, emphasize the role of early brainstem functions in the epiphenomena of ASD (Dadalko and Travers, 2018; Delafield-Butt and Trevarthen, 2018); namely, in social attention (Geva et al, 2017), communication (Geva et al, 2013, 2014), and repetitive behaviors (Cohen et al, 2013; Gandhi and Lee, 2021)– all key features of ASD. We suggest that brainstem circuits that mature in very early life and even during fetal stages to regulate vital autonomic functions (Zec and Kinney, 2003), have a central role in shaping social communication and adaptation of behavior. We suggest that given the early maturation of brainstem pathways, their pervasive role in functioning at multiple levels, and their specific involvement in social-communication deficits, brainstem functions enable a valuable window into the pathophysiology of ASD. We suggest that zooming out to look at the full battery of brainstemrelated expressions, rather than individual markers, may enable constructing a highly sensitive early risk neurobehavioral screening tool of ASD
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