Every day brings reports of new autism studies, most of which are of little or no obvious value, studies which show that a group of high functioning autism subjects are very intelligent, studies which show that some families of autistic children are relatively affluent, studies which purport to define an autistic "smile" and so on.
News of a study which claims to have established, using MRI bran scans, a biomarker for autism disorders is different. An autism biomarker may have profound and immediate impact on the very definition of autism as "Socrates" of the New Republic has already mentioned in Autism Diagnosis by MRI Brain Scan. Socrates gets right to the point while introducing a quote by one of the study authors Declan Murphy of King's College London:
"In an astonishing turn of events, the study due to be published later today, may throw into chaos the process for revising the DSM V definition of Autism.To date Autism has been defined solely on the basis of behaviour - a situation that is set to change radically.
I agree with Socrates. A reliable biomarker may throw the DSM5 autism revision process into chaos. In my view the drafters of the New Autism Spectrum Disorder in the DSM5 would be wise to stay their autism revision efforts until it can be determined whether this study receives widespread acceptance in the autism research community. If the study results are deemed reliable as indicating biomarker(s) for autism disorders than the revision process should stop until the full implications of the study are determined. There seems to be little point in revising definitions of autism disorders based solely on behavioral characteristics just as reliable biomarkers are being established and defined.
There could be many significant impacts of a reliable autism biomarker. The study authors speculate that the biomarker will help autistic people and their families by providing quicker, more cost effective diagnosis. I hope they are right. Private and public treatment and service providers will undoubtedly move to incorporate the use of the biomarkers into their criteria for determining whether to provide treatment or services. This could actually result in more waiting list delays for the scans which could simply be added on to existing eligibility requirements for receipt of services.
Current autism research conclusions including, possibly, epidemiological based vaccine research conducted during periods of changing definitions of autism in the DSM-IIII and IV, may have to be revisited using the new biomarkers. And of course some of the very high functioning persons currently diagnosed with Autism and Aspergers may lose their diagnostic labels ... and their careers as unelected, self appointed spokespersons for all "autistics". Debates about the use of functioning labels and differences of autism severity could become obsolete if clear biological/neurological distinctions are identified by MRI Brain Scans.
If the study results are confirmed and accepted by the autism research community the autism world may have just felt the first preshock of an autism earthquake that will reshape the autism world.
Information about the new MRI brain scan autism biomarker from the Medical Research Council:
Autism in adults diagnosed by quick, new brain scan
Tuesday 10 August, 2010
Scientists funded by the Medical Research Council (MRC) have developed a pioneering new method of diagnosing autism in adults. For the first time, a quick brain scan that takes just 15 minutes can identify adults with autism with over 90% accuracy. The method could lead to the screening for autism spectrum disorders in children in the future.
In the MRC-funded study, scientists at the Institute of Psychiatry (IoP), King’s College London, used an MRI scanner to take pictures of the brain’s grey matter. A separate imaging technique was then used to reconstruct these scans into 3D images that a computer algorithm can assess for structure, shape and thickness – all intricate measurements that reveal Autism Spectrum Disorder (ASD) at its root. Having developed this process, the computer can quickly pinpoint biological markers, rather than personality traits, to assess whether or not a person has ASD.
ASD is a lifelong and disabling condition caused by abnormalities in brain development. It affects about 1% of the UK population (over half a million people), the majority of these being men (4:1 male to female). Until now, diagnosis has mainly relied on personal accounts from friends or relatives close to the patient – a long and drawn-out process hinged on the reliability of this account and requiring a team of experts to interpret the information.
Dr Christine Ecker, a Lecturer in the Department of Forensic and Neurodevelopmental Sciences from the IoP, who carried out the study said:
“The value of this rapid and accurate tool to diagnose ASD is immense. It could help to alleviate the need for the emotional, time consuming and expensive diagnosis process which ASD patients and families currently have to endure. We now look forward to testing if our methods can also help children.”
Professor Declan Murphy, Professor of Psychiatry and Brain Maturation at the IoP, who led the research said:
“We think that our new method will help people with ASD to be diagnosed more quickly and cost effectively. Most importantly their diagnosis will be based on an objective ‘biomarker’ and not simply on the opinion of a clinician which is formed after an interview. Simply being diagnosed means patients can take the next steps to get help and improve their quality of life. People with autism are affected in different ways; some can lead relatively independent lives while others need specialist support or are so severely affected they cannot communicate their feelings and frustrations at all. Clearly the ethical implications of scanning people who may not suspect they have autism needs to be handled carefully and sensitively as this technique becomes part of clinical practice.”
Professor Christopher Kennard, Chair of the MRC’s Neuroscience and Mental Health funding board said:
“Bringing together the knowledge gained from neuroscience in the laboratory and careful clinical and neuropsychological evaluation in the clinic has been key to the success of this new diagnostic tool. In fact, this approach to research is a crucial theme throughout the MRC’s strategy. We know that an investment like this can dramatically affect the quality of life for patients and their families. The more we understand about the biological basis of autism, the better equipped we will be to find new ways of treating those affected in the future.”
The research studied 20 healthy adults, 20 adults with ASD, and 19 adults with ADHD. All participants were males aged between 20 and 68 years. After first being diagnosed by traditional methods (an IQ test, psychiatric interview, physical examination and blood test), scientists used the newly-developed brain scanning technique as a comparison. The brain scan was highly effective in identifying individuals with autism and may therefore provide a rapid diagnostic instrument, using biological signposts, to detect autism in the future.
The research was undertaken using the A.I.M.S. Consortium (Autism Imaging Multicentre Study), which is funded by the MRC. Support funding was also provided by the Wellcome Trust and National Institute for Health Research.
The paper, ‘Describing The Brain In Autism In Five Dimensions - MRI-Assisted Diagnosis Using A Multi-Parameter Classification Approach’ is published in the Journal of Neuroscience on Wednesday 11 August.
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