Autism:NeuralBasisandTreatmentPossibilities:NovartisFoundationSymposium251. Volume251.EditedbyGregoryBockandJamieGoode CopyrightNovartisFoundation2003.ISBN:0-470-85099-X AUTISM: NEURAL BASIS AND TREATMENT POSSIBILITIES TheNovartisFoundationisaninternationalscienti¢candeducational charity(UKRegisteredCharityNo.313574).KnownuntilSeptember1997 astheCibaFoundation,itwasestablishedin1947bytheCIBAcompany ofBasle,whichmergedwithSandozin1996,toformNovartis.The FoundationoperatesindependentlyinLondonunderEnglishtrust law.Itwasformallyopenedon22June1949. TheFoundationpromotesthestudyandgeneralknowledgeof scienceandinparticularencouragesinternationalco-operationin scienti¢cresearch.Tothisend,itorganizesinternationally acclaimedmeetings(typicallyeightsymposiaandalliedopen meetingsand15^20discussionmeetingseachyear)andpublishes eightbooksperyearfeaturingthepresentedpapersanddiscussions fromthesymposia.Althoughprimarilyanoperationalratherthan agrant-makingfoundation,itawardsbursariestoyoungscientists toattendthesymposiaandafterwardsworkwithoneoftheother participants. TheFoundation’sheadquartersat41PortlandPlace,LondonW1B1BN, providelibraryfacilities,opentograduatesinscienceandallieddisciplines. Mediarelationsarefosteredbyregularpressconferencesandbyarticles preparedbytheFoundation’sScienceWriterinResidence.TheFoundation o¡ersaccommodationandmeetingfacilitiestovisitingscientistsandtheir societies. 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NovartisFoundationSymposium251 ix+310pages,15¢gures,12tables LibraryofCongressCataloging-in-PublicationData Autism:neuralbasisandtreatmentpossibilities[editors,GregoryBockandJamieGoode]. p.cm.^(NovartisFoundationsymposium;251) Symposiumonautism:neuralbasisandtreatmentpossibilities,heldattheNovartis Foundation,London,18^20June2002. Includesbibliographicalreferencesandindexes. ISBN0-470-85099-X(alk.paper) 1.Autism^Congresses. 2.Autisminchildren^Congresses. 3. Neurophysiology^Congresses. I.Bock,Gregory. II.Goode,Jamie. III.Series RJ506.A9A92282003 618.92’8982^dc21 2003049714 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary ISBN047085099X Typesetin101(cid:1) on121(cid:1) ptGaramondbyDobbieTypesettingLimited,Tavistock,Devon. 2 2 PrintedandboundinGreatBritainbyBiddlesLtd,GuildfordandKing’sLynn. Thisbookisprintedonacid-freepaperresponsiblymanufacturedfromsustainableforestry, inwhichatleasttwotreesareplantedforeachoneusedforpaperproduction. Contents SymposiumonAutism:neuralbasisandtreatmentpossibilities,heldattheNovartisFoundation, London,18^20June2002 ThissymposiumisbasedonaproposalmadebyProfessorSirMichaelRutter Editors:GregoryBock(Organizer)andJamieGoode MichaelRutter Introduction:autism(cid:2)thechallengesahead 1 TonyCharman Epidemiologyandearlyidenti¢cationofautism:research challengesandopportunities 10 Discussion 19 AnthonyBaileyandJeremyParr Implicationsofthebroaderphenotypefor conceptsofautism 26 Discussion 36 G.BarnbyandA.P.Monaco Strategiesforautismcandidategeneanalysis 48 Discussion 63 SusanE.Folstein,MichaelDowd,RaymondMankoskiand OvsannaTadevosyan Howmightgeneticmechanismsoperateinautism? 70 Discussion 80 DavidSkuse X-linkedgenesandtheneuralbasisofsocialcognition 84 Discussion 98 GeneraldiscussionI 109 MargaretL.BaumanandThomasL.Kemper Theneuropathologyoftheautism spectrumdisorders:whathavewelearned? 112 Discussion 122 W.IanLipkinandMadyHornig Microbiologyandimmunologyofautism spectrumdisorders 129 Discussion 144 v vi CONTENTS ChrisFrith Whatdoimagingstudiestellusabouttheneuralbasisofautism? 149 Discussion 166 DavidG.AmaralandBlytheA.Corbett Theamygdala,autismandanxiety 177 Discussion 187 FrancescaHappe¤ Cognitioninautism:onede¢citormany? 198 Discussion 207 DorothyV.M.Bishop Autismandspeci¢clanguageimpairment:categorical distinctionorcontinuum? 213 Discussion 226 JanK.Buitelaar Whyhavedrugtreatmentsbeensodisappointing? 235 Discussion 245 PatriciaHowlin Canearlyinterventionsalterthecourseofautism? 250 Discussion 260 GeraldineDawsonandKathleenZanolli Earlyinterventionandbrainplasticity inautism 266 Discussion 274 Finaldiscussion 281 MichaelRutter Summing-up 289 Indexofcontributors 298 Subjectindex 300 Participants DavidG.Amaral UCDavisCenterforNeuroscience,1544NewtonCourt, Davis,CA95616,USA AnthonyJ.Bailey DepartmentofPsychiatry,UniversityofOxford, ParkHospital,OldRoad,Headington,OxfordOX37LQ,UK GillianBaird NewcomenCentre,UMDS,Guy’sHospital,StThomasStreet, LondonSE19RT,UK MargaretL.Bauman Children’sNeurologyService,MassachusettsGeneral Hospital,55FruitStreet,Boston,MA02114,USA DorothyBishop DepartmentofExperimentalPsychology,Universityof Oxford,SouthParksRoad,OxfordOX13UD,UK PatrickBolton DepartmentofPsychiatry,UniversityofCambridge,LevelE4, Addenbrooke’sHospital,HillsRoad,CambridgeCB22QQ,UK JanBuitelaar DepartmentofPsychiatryandAcademicCenterforChildand AdolescentPsychiatry,UniversityMedicalCenterStRadboud(Internal Post333),P.O.Box9101,6500HBNijmegen,TheNetherlands TonyCharman BehaviouralandBrainSciencesUnit,InstituteofChildHealth, 30GuilfordStreet,LondonWC1N1EH,UK GeraldineDawson UWAutismCenter,CenteronHumanDevelopmentand Disability,Box357920,Seattle,WA98195,USA SusanFolstein NEMCDepartmentofPsychiatry,750WashingtonStreet, Box1007Boston,MA02111,USA EricFombonne McGillUniversityDivisionofPsychiatry,Montre¤alChildren’s Hospital,4018SteCatherineOuest,Montreal,Que¤bec,CanadaH3Z1P2 vii viii PARTICIPANTS ChrisFrith WellcomeDepartmentofImagingNeuroscience,Instituteof Neurology,12QueenSquare,LondonWC1N3BG,UK UtaFrith InstituteofCognitiveNeuroscience&DepartmentofPsychology, UniversityCollegeLondon,AlexandraHouse,17QueenSquare,London WC1N3AR,UK FrancescaHappe¤ Social,GeneticandDevelopmentalPsychiatryResearch Centre,InstituteofPsychiatry,111DenmarkHill,LondonSE58AF,UK ChrisHollis DivisionofPsychiatry,EFloor/SouthBlock,Queen’sMedical Centre,NottinghamNG72UH,UK PatriciaHowlin DepartmentofPsychology,StGeorge’sHospitalMedical School,CranmerTerrace,LondonSW170RE,UK W.IanLipkin CenterforImmunopathogenesisandInfectiousDiseases, MailmanSchoolofPublicHealth,722West168thSt,ColumbiaUniversity,New York,NY10032,USA CatherineLord UniversityofMichigan,AutismandCommunication DisordersCenter(UMACC),1111CatherineStreet,AnnArbor,MI48109,USA AnthonyMonaco TheWellcomeTrustCentreforHumanGenetics,Roosevelt Drive,UniversityofOxford,OxfordOX37BN,UK MargaretPericak-Vance CenterforHumanGenetics,Departmentof Medicine,DukeUniversityMedicalCenter,Box3445,Durham,NC27710,USA NicoleRinehart DepartmentofPsychologicalMedicine,MonashMedical Centre,246ClaytonRoad,Victoria3168,Australia SallyRogers MINDInstitute,UniversityofCaliforniaDavis,4860YStreet, Room3020,Sacramento,CA95817,USA SirMichaelRutter(Chair) Box080SGDPResearchCentre,Instituteof Psychiatry,DeCrespignyPark,DenmarkHill,LondonSE58AF,UK RobertSchultz YaleUniversityChildStudyCenter,230SouthFrontageRoad, NewHaven,CT06520,USA PARTICIPANTS ix MarianD.Sigman DepartmentofPsychology,UniversityofCalifornia LosAngeles,FranzHall2344C,Box951563,LosAngeles,CA90095-1563, USA DavidSkuseBehaviouralandBrainSciencesUnit,InstituteofChildHealth, 30GuilfordStreet,LondonWC1N1EH,UK