According to Reuters, the BBC, and a whole slew of other news sources, British researchers have a developed a brain scan which can detect autism in adults with 90% certainty. Says the BBC News website:
Experts at King's College London said the scan - tested on 40 people - identified tiny but crucial signs of autism, only detectable by computer.
Current methods of diagnosis can be lengthy and expensive.
But some experts say further research will be needed before the new technique can be widely used.
There is no doubt that autism does go along with differences in brain structure, including an enlarged amygdala and other unusual features. It's also the case that other researchers have been working toward brain-scan-based diagnosis, and finding some success.
But it's not yet time to haul the brain scanners into every clinic.
In fact, the trial looked at a grand total of twenty adults with autism and twenty adults without. The outcome was promising, but hardly conclusive. And while the idea of a medical test for autism is enormously attractive, it will be a while before we can rely on such a process for clear, useful result.
As the BBC says:
Professor Uta Frith from UCL Institute of Cognitive Neuroscience, said much more work would be needed before the scans could be used for diagnosis. "This study shows that the subtle brain abnormalities associated with autism show a distinctive pattern," she said. "It is crucial that we learn more about what the brain abnormalities mean."
I read several reports about this. Many think it will lower the cost of diagnosis. While it will be less time intensive and cost less for the initial diagnosis, I think it’s very important to remember that you will still need a diagnostic team to help decide areas of deficiency and what path is needed to help the person overcome those areas. I think it will supplement what we already do to gain a diagnosis and treatment.
I’ve already read critiques about this research, so I wanted to offer some explanation for what this can and cannot do.
People don’t always understand why we don’t study *both* men and women in scan studies. We have to study one, or the other. Both studies have to be done eventually, but it is almost always easier to start with men. My wife says we are simpler creatures, which is oddly true neurologically.
This study, like most studies, is small and controlled so we can then plan yet more forward studies. You can’t study dozens of questions, only a single hypothesis with definite empirical instruments. Criticism is easy because no neurological study is comprehensive. Neurology can’t be comprehensive with current knowledge and instruments, so we study and map “dots” of the brain — the pixel groups of MRIs.
And people don’t realize what an MRI shows, which is only blood flow and signal activity, not what the activity means. For all we know, two brains active in the same regions are producing different results. Activity does not equal good or bad activity, so an MRI doesn’t offer quality of processing data that must be observed and tested via traditional means.
In other words, so far we can only confirm that adult males with ASD diagnoses have a tendency to exhibit certain brain activity patterns. (My MRI has anomalies, admittedly.) This does not mean *all* males with ASDs will exhibit these, but a large percentage do.
This study also cannot and does not pretend to answer how, why, or when the brain patterns develop. It is a very narrow study, which is how it has to be in order to be easily replicated by other universities. Once replicated by other researchers, then the hypothesis could be tested among women or younger men, for example.
I know that many people are never satisfied with such explanations, but the reality is we cannot easily study hundreds of people and locate minute differences. In fact, only a sophisticated computer analysis located some of the differences in this study. Then, those had to be verified by human review of the scan data. It takes two to three years for most studies of this kind, assuming a small sample size.
I read an estimate that reviewing 500+ brain scans in detail would take the best supercomputers five years. Then, you still need to have humans verify the results twice. That’s why researchers limit sample sizes.
I only reviewed a dozen or so scans during my doctoral work on language. It was overwhelming and made me glad I am not a neurologist.
Building on C.S.’s comment, the PR around this study, not the study itself, is what drives me nuts. The study was very small and some of the researchers comments were a bit too definitve in tone for my tastes.
The media is fed a lot of information that they are really unable to process effectively and give proper weight. Whether it’s the research team hyping their study/lab/institution to garner more funding or the “looking for magic bullets” media presenting autism as a monolithic one size fits all (as in this case), balance and accuracy are the usual victims.
Instead of focusing any more on this study, I’m going to tune in ABC World News Tonight to see a piece on the acute absence of supports for adults with autism and what we need to do about it. Hopefully the media will do a better job on that story.
http://blog.autismspeaks.org/2010/08/11/tune-in-august-11-abc-world-news-tonight/
Dadvocate: The media are not scientists, and even science reporters do a lousy job explaining things.
For example, this implies having an MRI would show differences that a doctor might notice. That is *not* the case. In fact, most MRIs in this study appear “normal” until analyzed by software — something no doctor, outside of research like this, has access to right now.
To those suggesting they had an MRI and it was normal — it probably was “normal” by most standards. In this case, the anomalies were so slight a special computer algorithm was used to detect them. Most neurologists wouldn’t have even noticed these.
Quite simply, the computer found differences we’d never notice without super high-resolution 3D images being fed into a computer. Even the best neurologists in the world don’t normally do such readings. Usually, MRIs are for major and obvious anomalies, not two or three pixel differences.
In other words, a normal MRI reading wouldn’t have detected what the special software did in these cases. It’s that small. Think having one slightly “grey” pixel on a 1440 x 900 screen of off-white pixels.
The news reports leave impression an MRI magically revealed an anomaly anyone could spot. That was not the case. Even the neurologists couldn’t see the anomalies without the aid of custom software running on very powerful computers.
Lousy reporting and headlines that lead people to say, “My kid had an MRI and there wasn’t anything wrong.”
So, CSWyatt – given that the anomalies are so small and require such specialized equipment to detect, how could such a “simple 15 minute test” ever become useful for ordinary evaluation? Seems you’d need a specialized lab, a super computer and a set of highly trained experts to even review the results!
Lisa
C.S. Looks like we agree 100%.
@autism:
If you have the special software, the actually scan is 15 minutes or less. Most people take longer, though. Getting someone with autism to remain still for a scan… good luck. The fact the scan is “15 minutes” does not mean the reading and analysis is done immediately.
I don’t know of any MRI lab here in Minnesota that has the neurologists on hand. A radiologist or similar expert does a quick read and forwards the data. Then, the data must be viewed. Most doctors simply look at a “picture” on screen, they don’t study the 3D data.
Again, if the experts are on hand? Probably 30 minutes to an hour of data processing, assuming you have a “data mask” that looks for the anomalies.
This is like saying a “one minute test” exists for low hemoglobin readings. Sure, it takes a minute to draw blood. Once in the lab, it might take five to ten minutes to process in the centrifuge… but I’ve never obtain lab results in six minutes.
C.S. and Dadvocate provide good solid information here; it’s a shame that the media usually does not. Like the urine test for autism, this too is being overplayed in the media. Yes, it’s interesting, but it’s preliminary and not likely to be used as a diagnostic tool any time soon. Plus, it certainly, if it is one day shown to be effective at diagnosing autism across the board, not going to be cheaper, not by a long shot.
Hi CS Wyatt –
Very nice analysis. Do you (or anyone) have a copy of the paper that they could use to strategically snip out more details on the differences found?
Thanks.
- pD
Actually, I do have the full subscription PDF. I know journals charge a fortune, etc, but I still have my univ. access.
For what it is worth, it my left frontal lobe that exhibits density and responsive anomalies. It matches these data. Weird and fascinating to me.
This is a sample of some of the material, limited to “fair use” length of controls) comprised several temporal regions, including the right superior temporal sulcus [Brodmann area 22 (BA22)], medial and superior temporal gyrus (BA21/ BA22), and the parahippocampal gyrus (BA36), fusiform gyrus (BA20), and entorhinal cortex. In addition, the excess pattern included the inferior/superior parietal lobe (BA39), BA18 of the occipital lobe, and the anterior and posterior cingulate gyrus.
The excess pattern comprised predominantly occipito- temporal regions, the pattern displaying a relative thinning of the cortex in ASD versus controls (i.e., “deficit pattern”) included mainly frontal and parietal regions such as the middle frontal gyrus (BA46), the medial/superior frontal gyrus (BA10), and BA46 in the medial frontal gyrus.
In the left hemisphere, SVM correctly classified 85.0% of all cases overall at a sensitivity and specificity as high as 90.0% and 80.0%, respectively, using all five morphological features.
Thus, our study provides further evidence to support the hypothesis that the “autistic brain” is not just bigger or smaller but is also abnormally shaped.
While we demonstrated that the neuroanatomy of ASD is multidimensional, the etiology of such multivariate differences remains unclear.
Sorry, the cut-n-paste mangled the information:
10612 The Journal of Neuroscience, August 11, 2010 30(32):10612–10623
Neurobiology of Disease
Describing the Brain in Autism in Five Dimensions—Magnetic Resonance Imaging-Assisted Diagnosis of Autism Spectrum Disorder Using a Multiparameter Classification Approach
pD, if you want more, e-mail me directly from my blog.
I am endowed with Asperger’s.
I saw in one of the news articles spawned by this study that the test could be as inexpensive as $157; I found that difficult to believe for an MRI and a professional evaluation, but I would certainly welcome it if it was true. I would love to have a non-subjective way to verify which members of my family have an autism spectrum disorder.
C.S.Wyatt illuminates an important aspect of this study in his wonderful posts here today: The autism is manifested in measurable physical differences in the structure of the brain. I cannot conceive of any mechanism by which a preservative in a vaccine, or a vaccine itself, can cause a change in brain structure on a macro scale, nor can I conceive of a pharmacological intervention which could correct brain structure on a macro scale.
Bill:
If further studies replicate the results, ideally at a number of research institutions in at least two additional countries, then it would seem to support the hypothesis the structure is inherently differentiated at birth. This is because some of the regions mentioned in the study are not commonly affected by external factors, from oxygen deprivation to chemical exposure.
The “thin” and “thick” patterns detected should be measurable with the best MRI equipment. If an MRI is in use often enough, the cost of a scan does decline dramatically.
Even if we demonstrate some or even most autism cases are caused by neural differentiation, that does not exclude any number of maternal, paternal, or environmental links at conception or during the first 16 weeks of embryonic development. Pre-birth, any number of factors can and do affect the brain and neurotransmitters. We already know “repair” transmitters are abnormally low in many autistic individuals. If a brain is damaged and cannot repair itself during embryonic stages, the results are permanent.
You wouldn’t recover from the damage, but you might be able to compensate, as we have seen with brain-damaged adults. The brain can and does “re-wire” itself in some instances. Plus, we have an amazing ability to retrain regions of the brain.
Mr. Wyatt:
I think we are on the same wavelength if I am interpreting your response correctly; structural changes in the brain associated with a majority of essential autism cases occur during gestation, not some time after birth, reinforcing my point that it makes vaccines less likely to be a culprit for a majority of autism cases.
I also totally agree that the behavior modification, either by choice because you don’t like being bullied, or by intense behavior training, will eventual create compensatory brain wiring, which helps, but is by no means a “cure”.
What bothers me is that here we have a real scientific advance, one that shows autism is neurological (regardless of cause), and people heading the fear-based, conspiracy-feeding organizations that soak up money won’t focus on this. Instead, they will keep promoting men like the the Griers who were recently reprimanded by the special master of the “vaccine courts” for padding their expenses.
Real research gets slammed by personalities because it is so difficult to explain the research process. Charlatans get speaking engagements and book deals.
This blog entry was one of the most important of recent months, and ignored by most readers based on the posted responses.
C.S. Wyatt (15) is confusing me a little; I don’t want to be too critical because I make typos plenty often too, but did he intend to type “Griers” sic or “Geiers”? (I couldn’t figure out what he was talking about, and Geiers made more sense judging from what popped up in Google.)
Your posts obviously show great intellect and access to the best literature giving you an inside track for making well reasoned decisions, but the writing style leaves ambiguities. The very last line, of (15), were you implying people are ignoring that autism is usually a function of brain structure, or ignoring that scans and software to measure brain structure will soon be available?
Personally I found the report anticlimactic; an accumulation of previous studies suggests abnormal brain structure proportions in autistics, so another study pointing it out doesn’t add much. I am an electrical engineer/controls/software guy, so automating scans is something I expected to happen; no surprise there. I found the 90% figure intriguing, but since it was such a small study, I wasn’t ready to herald it yet as being a definitive yardstick of much, other than the implication that a large percentage of autism is caused by measurable brain structure abnormalities, which I emphasized in my first post, and which then logically knocks the legs out from under suggestions that autism could be caused by any kind of early childhood intervention, since brain structures are already set at birth.
Hi Bill, not quite sure of your comment re brain structures being set at birth??
My understanding is that infections(encephalitis),drug abuse or toxicities, immune system reactions,learning, stress levels (abused children often have smaller corpus callosums) can all have huge effects on brain structure post natally. My understanding is that the plasticity of the human brain means brain structure can and does change post natally in many different ways in response to a variety of enviromental triggers .
Bill:
Indeed, my typing went sloppy as I bounced from work to blogs during lunch. What I meant to comment on was this regarding Mark and David Geier:
“Petitioner’s counsel requests $110,386.73 in costs related to S&A’s general hepatitis B work, of which counsel has earmarked $97,443.43 as costs (for fees and expenses) owed to Dr. Mark Geier and his son, David Geier.”
In the end, Dr. Mark Geier was paid $10,000 and David Geier was not compensated.
Yet, these two were quoted yesterday on several sites dismissing the MRI study. It was bothering me greatly this morning to see people claiming the MRI study was the latest example of pharma / Big Medicine trying to cover up the “truth” about autism.
A study of 20 isn’t really as small as it seems, based on statistical modeling. That’s hard to explain in a blog post, but a study of 50 randomly selected adults with autism is considered to be as accurate, statistically, as a study of several thousand. It’s the same reason you can predict an election with 1000 to 2000 voters in a nation of 300 million. As long as the sample is representative, there are several guides available on optimal samples sizes. (I have a book dedicated to nothing but sample sizes for various study purposes.)
I know some people imagine you need 10000 people or more in a study, but 20 is actually impressive for an MRI study that uses specialized analyses. If repeated two more times, that would be a total of 60 or more subjects and the *potential generalizability* of the conclusions to other adult males with an ASD would approach 80 percent or higher. (Basing this on Lawrence Neuman’s statistical models, admittedly not a neuroscientist, but a statistician.)
It simply bothers me that a study with potential for replication is being dismissed by what my wife calls “the usual suspects” on some websites and forums.
And yes, some structures are set on their developmental paths prenatally. While some seem to be alterable (certainly, parts can be destroyed), not all those measured in this test have demonstrated changes during life. Some have, some haven’t. This study leads me to wonder if these developmental patters aren’t, in fact, established before the first year of age if not much sooner.
It’s a huge study with lots and lots of data tables to analyze.
C.S.Wyatt,as you may know, a recent study of vaccinated/unvaccinated monkeys(admittedly very small)showed early brain structure differences between the monkeys who received vaccinations, and those who did not.
I agree about the importance of replicable studies.
A representative population of autism would need address the many different ‘flavors”of autism;nonverbal,verbal,regressive autism, apergers, autism with co occuring mental retardation, gentic autism(fragile x syndrome) It is deeply unlikely that all aspects of autism were represented at all in this study of 20 people, let alone in the correct percentages needed to provide a representative sample..Still though,interesting results..
Hera – one issue that keeps coming up for me is the question of what, in fact, is a “legitimate flavor of autism?” For example – is “verbal autism” a useful category? How about “autism with seizure disorder,” or “verbal autism with anxiety?”
Not sure if we’re really able to parse that question yet.
Lisa
Hera (19):
The “monkey study” has numerous problems, including changes to the dataset that were made after the study. You should never drop control groups, alter the subject data, and so forth, before publishing.
Most of the original authors also dropped their names from the study. The study is more than two years old, and was based on 1994 vaccine protocols, for example.
Furthermore, the data showed such slight brain changes — first a shrinkage and then greater growth over a two-year period. These changes were actually matched by the control group that was omitted from the revised publication. In other words, a control showed similar changes, so it was dropped to make the study look good.
The “study” was published by Thoughtful House Center for Children, Austin, TX, USA in a Polish journal that accepts paid articles and minimal peer review. That’s not good science.
These are the official credits on the study, noticing that 13 names vanished between draft and publication and the study was withdrawn from U.S. and U.K. peer-review:
Hewitson L., Lopresti B., Stott C., Mason N.S., Tomko J.
These individuals have also served as paid consultant to anti-vaccine groups (Hewitson in particular).
I know that won’t change any minds, but a study with a biased sponsor is a problem. And “Thoughtful House” has a definite agenda. Wakefield has no credibility.
C.S. Wyatt, after reviewing the study, I note that 9 of the experimental group and 2 of the control group of monkeys were scanned. I did not read anything about a control monkey having similar brain dysfunction; please, what was your source for that information?
If it is somewhere in the original study and I missed it could you point it out please?
Perhaps you have some other peer reviewed journal source for the allegations?
I am also interested in the very recent link suggested betwen tylenol and asthma. Tylenol has been used since 1955. It has been repeatedly reviewed and study in well known peer reviewed journals . It clears the blood relatively quickly, is not identified as causing acute resipratory problems,; and yet 55 years later, we are discovering it could potentially have long term effects on lung function/the development of asthma,effects that are only being identifed when we compare those who take it, with those who do not..Food for thought perhaps.