Jane’s Brain: Neuroethics and the Intelligence Community

By Jonathan D. Moreno, PhD



Dr. Jonathan D. Moreno is one of 14 Penn Integrates Knowledge university professors at the University of Pennsylvania, holding the David and Lyn Silfen chair. He is also Professor of Medical Ethics and Health Policy, of History and Sociology of Science, and of Philosophy. Moreno is a Senior Fellow at the Center for American Progress in Washington, DC. In 2008-09 he served as a member of President Barack Obama’s transition team. He is also a member of the AJOB Neuroscience Editorial Board.



In September I arrived in Geneva to keynote a conference at the Brocher Foundation on the banks of Lake Geneva, where the ghost of John Calvin still casts a long shadow over the stern ethos of the Swiss. It was a glorious day in that oasis of calm and cleanliness, where the sheer power of holding much of the world’s money in its vaults justifies a muffled smugness. Compulsively, I checked my email as my taxi glided past the Hotel President Wilson, the monument of grateful bankers to the American president whose ill-fated League of Nations nearly made Geneva the official as well as de facto capital of the world. (Its $81,000 a night penthouse suite is said to be the most expensive in the world; I didn't stay there.)



 The habit of holding meetings of the great and powerful in Geneva is hard to break. The UN has an important complex there, along with WHO of course, and many other global organizations. I was told that the city’s main business, besides banking, is international conferences. That week a few dozen bioethicists were to meet on one end of the lake, recognizing the impending 50^th anniversary of the Declaration of Helsinki, while at the other end of town (only announced after we arrived), Secretary of State John Kerry was to meet with his Russian counterpart Sergey Lavrov to pencil a deal on Syria’s chemical weapons. I feel sure this was a coincidence, though there were some people at the bioethics meetings who could have told them a thing or two about chemical weapons. No word if the Secretary took time out for wind surfing on the Geneva, but it was reported that he did take a nice walk in the hills overlooking the lake after his meetings when he had a cell phone call with the President.



But about that email.



By far the most interesting item was an invitation from the deputy editor of a publication called Jane’s Intelligence Review (JIR), which specializes in news intelligence analysts can use. For their November issue they wanted to know if I would write an article about neuroscience and national security. I knew enough about the Jane’s journals to appreciate that they are the “go to” source for up to date information on developments in the field of defense and security. The company is a descendent of a late 19^th century Brit named Fred Jane, who combined his knack for sketch artistry with an obsession about the naval vessels docking in Portsmouth. The result was the famous illustrated compendium Jane’s Fighting Ships, still updated annually, along with a number of other publications under the imprimatur of the eccentric Jane.

Having been around the block called bioethics and national security a few times (my book Mind Wars appeared in an updated paperback edition in 2012), I saw the invitation as a modest milestone for neuroethics. So far as I knew this was the first time that JIR expressed a specific interest in the field, so I needed little persuasion. The intelligence world has shown other signs of tracking neuroscience, including relevant reports by the national research council in 2008 and 2009 and one forthcoming in the next few months, but Jane’s gives the subject a greater currency. So did the negotiations over Syria’s chemical weapons. The editors clearly appreciated the connection of developments in neuroscience to the control over the development, manufacture and use of toxin weapons. They were also aware of the brain-to-brain interface experiment reported by the team at the University of Washington, Seattle, which helped stimulate their curiosity about the links to more traditional chemical weapons with neurologic effects.



If you happen to have a subscription to Jane’s online you can read the piece here, otherwise you’ll have to wait for the print version in a few weeks.





Editor's note:



Want to read more about ethical issues related to brain-to-brain interfacing? Emory graduate student, John Trimper, in collaboration with Drs. Rommelfanger, Director of Emory's Neuroethics Program and Wolpe, Director of Emory's Center for Ethics also recently published an article on ethical issues related to brain-to-brain interfacing in Frontiers in Neuroengineering. The open access article can be viewed here.

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Moreno, J. (2014). Jane’s Brain: Neuroethics and the Intelligence Community. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/02/janes-brain-neuroethics-and.html

Can Neuroscience Data be Used to Minimize the Effects of Stereotype Threat?

Last December 2013, the neuroscience graduate students at Emory University spearheaded an effort alongside many other sponsors to organize and implement a symposium to explore the neuroscientific basis of race and gender bias. The program, entitled “Bias in the Academy: From Neural Networks to Social Networks,”  awarded the Laney Graduate School New Thinkers/New Leaders fund and support from CMBC and the Center for Ethics, aimed to provide students and faculty alike an overview of the psychological and neuroscientific research on race and gender bias and how this might be used to mitigate harmful effects of stereotype and bias in the academy. After listening to and participating in the symposium, I realized that the symposium speakers and student planners all hoped to answer a similar question regarding the nature of the brain: Is the brain “hard-wired” to categorize people into groups in a way that makes negative stereotyping inevitable or is the brain exquisitely plastic insofar as biases we hold toward groups can be altered via certain interventions? One individual cannot find the answer to this question; rather, multidisciplinary scholarship can work to bridge the gap between disciplines such as neuroscience and social psychological findings that begin to answer this question and real-world issues.

The speakers at the symposium explored various aspects of race and gender bias.  First, Dr. Liz Phelps, a Julius Silver Professor of Psychology and Neural Science at New York University, presented and explained her work on race bias in a talk entitled, “The Neuroscience of Race Bias.” In particular, Dr. Phelps’ work focuses on the cognitive neuroscience of emotion, learning, and memory. In her talk at our symposium, she delved deeply into her work regarding the acquisition, expression, and inhibition of race bias. She discussed the nature of the prepared learning effect in addition to the ways in which examining amygdala activation may help to understand why we develop certain predispositions to objects and people.





Second, Dr. Chad Forbes, a social neuroscientist at the University of Delaware, also sought to outline how the recipients of bias may feel or act when put in situations that may elicit feelings of inferiority in his talk entitled, “Gaining Insight from a Biased Brain: Implications for the Stigmatized.” Specifically, Forbes discussed his work in which he used EEG to detect stress in subjects who were thought to be a victim of stereotype threat. He presented findings from his work that focused on how negatively stereotyped targets’ attention, memory, and motivation may be different in stress-inducing contexts.





Finally, the symposium ended with Greg Walton’s, an Assistant Professor of Psychology at Stanford University, talk entitled, “Wise Interventions: Engineering Psychology to Raise Achievement.”  He explored how simple social belonging interventions can significantly alter a student’s academic trajectory. He specifically discussed how many minority students tend to find that they feel particularly excluded during the transition to college from high school. For instance, an undergraduate minority student may feel ostracized when their roommate does not invite him or her to dinner or an advisor fails to respond to an email promptly. Some students may experience these negative events and automatically interpret them to mean that the student does not belong at the university. Ultimately, Walton proposes that specially crafted interventions that target these misguided cognitions may provide an important area of study when approaching ways in which colleges can help all students perform well academically.



The symposium concluded with several other events including a presentation by graduate students that synthesized the information presented by the speakers and a panel discussion moderated by the Director of the James Weldon Johnson Institute for the Study of Race and Difference, Tyrone Forman. By incorporating these interactive components into the symposium, the Emory graduate students hoped to put many of the psychological and neuroscientific findings presented by the speakers into an academic context and spur conversations regarding issues of gender and race bias at Emory.  Many of the questions asked by the audience focused on how we can take the information from the talks and apply the psychological findings at an institutional level to precipitate change. In an effort to further understand higher education, institutions can utilize neuroscience data to minimize the effects of stereotype threat in academic settings.



One of our speakers, Chad Forbes provided us with some additional insight on three ways he felt neuroscientific findings may inform strategies to mitigate bias:



1. Forbes suggests that neuroscience techniques may provide a novel lens for examining consequences of bias:



“Traditional approaches to understanding the deleterious consequences of stereotypes and prejudice in academic settings have relied primarily on self-report and behavioral measures like reaction time tasks. While there is no better way to examine individuals' meta-cognitive interpretations of their impressions of others or how they feel in a given situation, these approaches are inherently vulnerable to individuals' self-presentation concerns, self-enhancement biases and egalitarian-oriented motivations.  Indeed, if given time individuals can easily override or disguise initial reactions to outgroup members that otherwise have profound effects on perceptions and behavior. Advances in neuroscience methodologies and the data that has emerged from these investigations has engendered a scientific revolution that has allowed researchers to circumvent these issues in a multitude of ways.”



2. In addition Forbes suggests that neuroscience allows us to design experiments where in researchers can examine psychological phenomena as they happen real time. 



“Importantly, to the extent activity in different neural regions (either alone or in concert with other regions) engender specific psychological processes neuroscience methodologies provide a means to unobtrusively examine different psychological phenomenon on-line, while individuals interact with intergroup members, or interpret, receive or deliver information to ingroup and outgroup members. To this end it is possible to index responses that individuals are either not comfortable disclosing or are unaware of experiencing (e.g., an individual is unaware of the visceral, negative affective reaction they elicit in response to an outgroup compared to ingroup member).”



3. He also suggests that these methodologies allow for the design of new interventions.



“Furthermore, neuroscience methodologies, particularly EEG, also affords the possibility to examine the time (on the order of milliseconds) with which different psychological processes unfold. Armed with this information, social neuroscientists can design strategies that are more effective at mitigating bias experienced and elicited in academic settings. These strategies could conceivably identify optimal approaches, such as whether a cognitive or affective based message might be more effective and whether strategies should address basic psychological phenomenon like learned associative processing or more meta-cognitive approaches that target higher level cognitive processes. In short, neuroscientific data can only broaden and enrich our understanding of both the effects of bias and stereotypes on individuals' perceptions and behaviors and optimal means to eradicate these effects."



I agree with Dr. Forbes and see the value in these approaches. I also do not think that neuroscience holds all the answers to resolving complex societal problems.  I, along with all the symposium planners and speakers, do think that neuroscience brings something unique to the discussion. The work of Dr. Forbes and Dr. Phelps reinforces the notion that the brain is equipped with the anatomy to enact and feel bias. Their work and the work of Dr. Walton also suggest that the brain is equipped to learn to adapt to change these biases. Dr. Forbes' work also reinforces the idea that neuroscience data may be useful in learning just how and when we might implement behavioral interventions.



The symposium represented a first step toward understanding the biological basis of bias, the brain of the stigmatized, and the potential interventions that exist to mitigate bias. It is our hope that we can continue to explore the neuroscience of bias, the benefits of diversity, and the action steps we can take as an institution to resolve our pressing diversity issue in the coming years.







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Marshall, J. (2014). Can Neuroscience Data be Used to Minimize the Effects of Stereotype Threat? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2013/11/the-future-of-law-and-neuroscience.html

“Faith, Values and Autism” A Symposium Held by the Marcus Autism Center and the Atlanta Autism Consortium

On December 13, 2013 the Marcus Autism Center and the Atlanta Autism Consortium co-hosted a mini-symposium looking at the role of faith and religion in the lives and well-being of individuals living and working with Autism Spectrum Disorder (ASD). Organized by Marcus psychologist Dr. Samuel Fernandez-Carriba and Georgia State professor Dr.  Anne-Pierre Goursaud the event, titled “Faith, Values and Autism,” included a panel of six individuals from a variety of faith perspectives and featured a presentation by Dr. Alfiee M. Breland-Noble on the development and implementation of faith based mental health promotion. This topic has important implications for neuroethics and neurodiversity, the perspective that autism and other neurological disorders are part of natural human neurological diversity that should be neither cured nor normalized.

The religious or faith-based perspective of a family impacts how the presence of autistic traits in a child is framed. Some religions, for example, may connect autistic difference to experiences in a past life, a state of being that is closer or further from God than non-autistic individuals, or a test from God. A non-religious caregiver or autistic individual[1] may be more likely to accept and discuss biological or genetic causal models than those with strong religious doctrines. For example, during my dissertation research, for which I studied perceptions of autism in India, I learned that genetic causal models are more stigmatizing than explanations of evil eye or maternal pre-natal behavior because it is seen as more permanent and transmissible through the family’s ‘bad blood.’ Understanding a family’s or individual’s faith perspective can help professionals understand treatment decisions as well as develop more trusting doctor-patient relationships. Both of these benefits can greatly enhance the efficiency of autism-related interactions, from diagnosis to planning for transition into adulthood. 

Some families find difficulties participating in religious communities because some traditions do not accommodate autistic children, who may find it difficult to follow religious restrictions related to diet, silence during services, and/or recitation of texts. However, as this panel demonstrated, religious communities can also be important sources of support and help spread a message of acceptance of families and individuals on the autism spectrum. This event drew professionals and autistic adults from around the community to discuss and ask: What role does religion and faith play in the lives of families with autism and the approach professionals take with families and autistic individuals? 

Dr. Samuel Fernandez-Carriba

The event began with an introduction by Dr. Fernandez-Carriba. He explained that when psychologists research quality of life, they rarely include such items as values, goals, and dreams. These items, he explained, are personal (yet universal) and difficult to operationally define and measure using the scientific method, which is the accepted mode of research for the profession. Because of this, psychological research on quality of life usually focuses on items such as personal assessments of one’s physical and mental health; engagement in self-care, work, and leisure activities (which may include participation in religious institutions); sleep patterns; opinions about one’s looks, intelligence, happiness, and/or confidence; lifestyle features such as education and employment; and sex and relationship patterns.[2] Therefore, research has been conducted on the effect of being religious and part of a religious community on health, but not so much on how religion and faith can frame the ways illness, disability, and normality are defined and (de)valued. Each person's religious (or non-religious) views on these concepts have a profound impact on their health and quality of life and should be included in our approach to health care to make it truly comprehensive, individualized and, thus, universal. 

With disabilities like ASD, spirituality can lead to causal explanations, such as those described above, that diverge from what scientists or clinicians generally accept as likely causes (i.e., genetic or environmental factors).[3] One study looked at Ultraorthodox Jewish communities in Israel families and found that caregivers understand their autistic children as having a direct line with God, a belief that was mentioned at this symposium by psychologist and follower of the Jewish faith, panelist Moshe Manheim. Professionals who do not respect this belief may alienate families, leading them to reject their advice or assistance. They may also fail to fully appreciate the difficulties families have in their communities and make false assumptions about a families priorities. For instance, the above study also described how these families struggle to find ways to gain community acceptance for their children, who may not be able to study scriptures or follow doctrines and rules of purity in the Ultraorthodox religion.[4] Without a discussion about religious beliefs, professionals in this situation may not understand the importance for an autistic child to learn to, for instance, tolerate certain cleansing rituals. 

The symposium included perspectives from the Hindu, Christian, Buddhist, Jewish, and secular perspectives. Each panelist presented unique and personal perspectives, including Dr. Meenakshi Lambha’s description of the Hindu belief in karma, which states that we are all working through particular deeds and debts from our previous and current lives. ASD is a part of karma and so is considered to be temporary (because it is just a part of the current life) and exactly what affected individuals and those around them can and should handle. Dr. Norma Harris described her experiences with the Buddhist faith perspective by explaining that we, and everything in our life, is permeable, that is constantly changing and impermanent. Extending this understanding to a label of autism means that this diagnosis is also fluid and should not cloud over the presence of a life. This particular belief is well aligned with the concept of neurodiversity. As the panel proceeded, it became clear that the overarching theme was that of community and acceptance. Each panelist described how their religious perspective worked towards creating a community in which an autistic individual and their family can find inclusion and acceptance.

Reverend Jamie Butcher

This was perhaps best exemplified by Presbyterian pastor, Reverend Jamie Butcher, and her congregant, Jeff Moen, a father of a significantly autistic child. Reverend Butcher described how her church has purposefully worked towards finding creative ways to work with and for families with autism and related needs. They have education programs, parent respite care, and special worship services for these families. It was in these overt efforts that Jeff Moen and his family found comfort and community. He said this church “brought them into a new world,” one in which they could follow their faith, and he was grateful for it. This notion was furthered when Dr. Fernandez-Carriba described how mediation has helped his work with autistic people and their families. He reminded attendees that all belief systems are based on the desire and quest for happiness, in which awareness and acceptance of reality is essential to realize this aspiration. Also essential is the community as a system in which one’s happiness is reliant on the happiness of others.

Dr. Breland-Noble

Harnessing the power of religious community is one of the driving forces behind Dr. Breland-Noble’s efforts towards Faith Based Mental Health Promotion. Although her work is primarily focused on depression in African-American communities, particularly with African-American youth, it has implications for all mental health-related issues, including ASD. She uses Community Based Participatory Research in primarily Protestant, African-American churches to encourage youth to recognize signs of depression and seek help. She targeted this community because of the high reports of religious belief and church attendance in African-American communities and low rates of mental health care usage. By engaging with church leaders and sharing real narratives of depression, often presented by the affected individuals, she develops programs that put a face to the problem and identifies barriers and promoters to help-seeking. Her work has been published in notable journals such as the Journal of Child and Family Studies, Journal of Clinical Psychology in Medical Settings, and the Journal of Clinical Psychology.[5]  

Incorporating a consideration of faith and religion into any work with ASD and related disabilities has vast benefits. When thinking about having neurodiverse practices, it is beneficial to include thinking about being mindful of diverse religious traditions and ways to strengthen relationships between professionals and families through a deeper understanding of priorities, goals, and causal models. Qualitative research should be done to help professionals more fully understand how faith impacts autism-related advancements such as early screening technologies and pre-natal diagnosis. These emerging technologies will be considered differently by families from different faiths who have varying perspectives on acceptance of difference, medical interventions, abortion, and the allocation of family time and resources. For my project at the Marcus Autism Center, which is focused on the neuroethical implications of using eye-tracking technologies for early autism screening and detection, gathering information about the role of faith in families could become an important recommendation for clinicians using this technology. Dr. Fernandez-Carriba summarized this approach by describing how he aims to ensure he asks families about their faith beliefs in his clinical practice by always asking: “What do you need?” This is a simple, effective way to ensure the family and child is central to all intervention, educational, and therapeutic efforts. It is also a reminder of everyone’s shared primary goal: improving the lives of autistic people and their families. 

1. My use of the term “autistic individuals” as opposed to the frequently used “individual with autism” is a reflection of preferences among autistic self-advocates who reject the use of people-first language. People-first language has been and still is used by disability advocates as a linguistic reminder that the disability is not as important as the person by placing a disability label last. However, the autistic self-advocates I have worked with and befriended assert the importance of their autism in their identity formation, and so prefer to have it listed first. They also reject the apparent need remind people that autistic people are, in fact, people through the use of people-first language. Because of their preferences, I rely on the use of ‘autistic people’ with the understanding that it is a sign of respect and solidarity. 


2. For example, see: Abler, J., Delhey, J., Wolfgang, K., & Nauenburg, R. (2004). Quality of Life in Europe: First European Quality of Life Survey, 2003. Luxembourg: Office for Official Publications of the European Communities; Hawthorne, G., Richardson, J., & Osborne, R. (1999). The Assessment of Quality of LIfe (AQoL) instrument: A psychometric measure of health-related quality of life. Qual Life Res., 8(3): 209-224; National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. (2011). “CDC HRQOL-14 ‘Healthy Days Measure.’” Centers for Disease Control and Prevention: Health Related Quality of Life (HRQOL). Retrieved from http://www.cdc.gov/hrqol/hrqol14_measure.htm.; World Health Organization. (2002). WHOQUOL-HIV Instrument. Geneva: World Health Organization. Retrieved from http://apps.who.int/iris/bitstream/10665/77774/1/WHO_MSD_MER_Rev.2012.01_eng.pdf.;


3. Daley, TC. (2004). From symptom recognition to diagnosis: children with autism in urban India. Social Science & Medicine, 58: 1323-1335; Dhar, RL. (2009). Living with a developmentally disabled child: Attitude of family members in India. The Social Science Journal, 46: 738-755; Vaidya, S. (2009). A Sociological Study of Children with Autism in Delhi: Issues and Challenges. Paper presented at Asian Pacific Autism Conference, Sydney, August 21.


4. Shaked, M. & Bilu, Y. (2006). Grappling with affliction: Autism in the Jewish Ultraorthodox community in Israel. Culture, Medicine, and Psychiatry, 30: 1-27. 


5. Breland-Noble, A.M. & Weller, B. (2012). Examining African American Adolescent Depression in a Community Sample: The Impact of Parent/Child Agreement. Journal of Child and Family Studies. 21(5), 869-876. doi: 10.1007/s10826-011-9547-z; Breland-Noble, A.M. (2012). Community and Treatment Engagement for Depressed African American Youth: The AAKOMA FLOA pilot. Journal of Clinical Psychology in Medical Settings, 19(1), 41-48; Breland-Noble, A.M., Burriss, A., Bell, C.C. & The AAKOMA Project Adult Advisory Board. (2011).  “Mama just won’t accept this”: Adult Perspectives on Engaging Depressed African American Teens in Clinical Research and Treatment. Journal of Clinical Psychology in Medical Settings, 18(3): 225-234, DOI:10.1007/s10880-011-92356; Breland-Noble, A.M., Bell, C.C., Burriss, F.A., Poole, H.K. & AAKOMA Project Advisory Board. (2011). The Significance of Strategic Community Engagement in Recruiting African American Youth & Families for Clinical Research. Journal of Child and Family Studies, 21(2): 273-280, DOI:10.1007s10826-011-9472-1; Burriss, F.A., *Breland-Noble, A.M., Webster, J., & Soto, J. (2011). Juvenile Mental Health Courts for Adjudicated Youth: Role Implications for Child and Adolescent Psychiatric Mental Health Nurses. Journal of Child and Adolescent Psychiatric Nursing, 24(2): 114-121. *equal contribution; Breland-Noble, A. M., Burriss, A., & Poole, H. K. (2010). Engaging depressed African American adolescents in treatment: Lessons from The AAKOMA Project. Journal of Clinical Psychology, 66(8): 868-879.

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Sarrett, J. (2014). “Faith, Values and Autism” A Symposium Held by the Marcus Autism Center and the Atlanta Autism Consortium. The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/02/faith-values-and-autism-symposium-held.html

Neuroethics Journal Club: How early can signs of autism be detected in infants?

Autism Spectrum Disorder (ASD) is a complex disorder typically characterized by social impairment and communication deficits, and most recently the CDC has estimated that 1 in 88 American children are affected by a form of ASD.¹ A reliable diagnosis for autism can be offered at 24 months, but most children are diagnosed later after attending school. For the first Neuroethics journal club of the spring semester, ILA graduate student and Neuroethics Scholar Jennifer Sarrett led a discussion on a new technology that could offer preclinical risk assessment in children as young as 2 months.



Even though children and adults with autism exhibit a wide variety of individual and unique symptoms, a common attribute of those diagnosed with autism is a deficit in the ability to make eye contact. In a paper published in Nature late last year, researchers from the Marcus Autism Center and Emory University School of Medicine used special eye-tracking equipment to measure eye fixation in children only 2 months of age and were able to observe the earliest signs of developing autism ever recorded.² Infants that were enrolled in the study were measured at 10 different time points between the ages of 2 months and 24 months, and then an autism diagnosis was made at 36 months. Infants were classified as either high-risk for ASD if a full sibling had already been diagnosed with ASD or low-risk if no first, second, or third degree relatives were affected by the disorder. Eye-tracking was analyzed at each of the time points for 36 boy infants, 11 of which were later diagnosed with ASD (10 from the high-risk group and 1 from the low-risk group) and 25 of which were classified as typically developing. At each of these time intervals, infants watched videos of a caregiver behaving in a natural, standard manner, and the amount of time each infant fixated visually on the eyes, mouth, body, and objects in the room was measured. It was hypothesized that in the children later diagnosed with autism, a deficit in the attention given to the caretaker’s eyes would be observed beginning from the earliest time point measured.

In 2002, the first study of this kind to use eye-tracking equipment to research autism was conducted.³ Male adolescents with autism and males that had not been diagnosed with autism were recruited to watch 5 clips from the 1967 movie “Who’s Afraid of Virginia Woolf,” chosen due to the socially intense interaction of the four main characters.⁴ The movie includes many highly complex social situations that would warrant a viewer’s fixation on a character’s facial expression and bodily actions. While those in the study watched the clips, eye-tracking equipment was utilized to track visual fixation of the two groups. Individuals from the autism group were more fixated on the mouth region, the body region, and object region than their peers that had not been diagnosed with autism. The largest difference in visual fixation was that of the eyes though; those from the autism group fixated 2 times less on the eyes and this was the best predictor of which study group an individual was associated with.

Yellow = Control viewer, Orange = Viewer with autism³

Just like in the seminal 2002 experiment, when tracking the eye movement of infants watching a naturalistic caregiver, researchers observed a stark difference in the visual fixation patterns of the infants later diagnosed with autism and the typically developing control group.  In typically developing male infants, eye fixation was highest from 2 to 24 months compared to mouth, body, or object fixation. Mouth fixation increased from 2 to 12 months and was highest at approximately 18 months, while body and object fixation declined from the 2 to 24 month period. In the infants later diagnosed with ASD, eye fixation declined at the 2 month mark until the end of the testing period, eventually reaching a level that was half of the typically developing group. Similar to the control group, body fixation declined, but at half the rate of typically developing infants and at 24 months was 25% higher. Object fixation also declined initially from 2 to 18 months, but then increased and at 24 months was twice as high as the control group. Similarly to the typically developing male infants, infants later diagnosed with autism also showed a mouth fixation increase from 2 to 18 months. Although researchers observed a different pattern for visual fixation in each of the four regions, especially fixation to the caregiver’s eyes, over the 2 year period when comparing the control group and those later diagnosed with autism, notably at the 2-month mark, infants with autism show visual fixation to eyes in the normative range. All infants regardless of which group they belonged to in the study began with a visual fixation time to the eyes between approximately 40 and 50%, but only those with autism showed a sharp decline after 2 months. This finding disproves a long held hypothesis by those well familiar with autism – that this particular symptom of autism begins immediately following birth. This study instead suggests that there is a small window, from birth to 2 months, where visual fixation to the eyes in not impaired, and could be very exciting in terms of treatment for autism since as the authors of the paper state “predispositions that are initially intact suggest a neural foundation that may be built upon, offering far more positive possibilities than if that foundation were absent from the outset.”²



A new technology that has the potential to be used as a screening tool for autism would be incredibly helpful for the field, since it has been shown that early diagnosis and early therapies can improve a child’s delayed development.⁵ However, therapies for autism including speech and language therapy, usually occur between 12 and 18 months, at the earliest. If risk assessment is made between the ages of 2 and 6 months and the only obvious symptom is declining eye contact that has been made with specialized, sophisticated technology that currently is not even used in a clinician’s office, what therapies would be utilized and what development skills would therapy target? The earlier autism is detected, the better for the child, but is it also possible that there would be an age where the diagnosis would be unnecessary, or even detrimental? As this new technology is more widely used and if the results are confirmed in a larger population, researchers are more likely to develop intensive therapies for infants in an effort to rehabilitate children who show signs of autism at a very young age.



ASD can be expressed in children and adults in a variety of forms with varying levels of severity. While parents of a severely autistic child who is unable to communicate would most likely appreciate intensive therapies given at a young age in an effort to lessen the effects of autism, many advocates of neurodiversity would rather find ways to accommodate and help those afflicted with autism and not find new methods for extreme rehabilitation. Proponents of neurodiversity often believe that many neurological disorders, such as ASD, are a natural result of the genome and neurodiversity is crucial to society.^6,7 Attempts to eliminate all autistic expression from children using early-intervention autism assessment or therapy would go against the tenets of neurodiversity and be seen as completely unnecessary.



The idea of neurodiversity and how neurodiversity applies to autism is a complex idea, in part because autism is such a diverse disorder. No two children with autism behave the same or are affected at the exact same level of severity. As researchers and clinicians move forward with very early therapeutic interventions and even earlier risk assessments, children will have to be considered individually. Screening for autism at an infant age may be useful or even necessary for children with a high-risk for autism, and based on the results, it may not be advisable to wait until a child reaches 12 to 18 months to start therapy. While researchers observed that a steeper decline in visual eye fixation was related to a more severe social disability, results also suggest that initial visual fixation to the eyes following birth into the first couple of months of life is not reliant on whether or not a child has autism. This offers the hope that there are more therapies for autism to be explored – those that build on a neural foundation and normative social behavior observed in infancy, and not necessarily a remedial program that works to adjust social behavior and visual fixation deficits.





References:



1) Autism Spectrum Disorders (ASDs). Centers for Disease Control and Prevention ASD homepage. Retrieved on January 28, 2014, from http://www.cdc.gov/ncbddd/autism/facts.html



2) Jones, W., Klin, A. (2013). Attention to eyes is present but in decline in 2-6-month-old infants later diagnosed with autism. Nature 504, 427.



3) Falck-Ytter, T., Bölte, S., Gredebäck, G. (2013). Eye tracking in early research. J Neurodev Disord 5, 28.



4) Klin, A., Jones, W., Schultz, R., Volkmar, F., Cohen, D. (2002). Visual fixation patterns during viewing of naturalistic social situations as predictors of social competence in individuals with autism. Arch Gen Psychiatry 59, 809.



5) What is Autism? Autism Speaks. Retrieved on January 28, 2014, from http://www.autismspeaks.org/what-autism



6) Sarrett, J. (2013). Why is Neurodiversity Useful? The Neuroethics Blog. Retrieved on January 28, 2014, from http://www.theneuroethicsblog.com/2013/12/why-is-neurodiversity-useful.html



7) My Life With Asperger's. Psychology Today. Retrieved on January 28, 2014 from http://www.psychologytoday.com/blog/my-life-aspergers/201310/what-is-neurodiversity.







Want to Cite This Post?



Strong, K. (2014). Neuroethics Journal Club: How early can signs of autism be detected in infants? The Neuroethics Blog. Retrieved on , from http://www.theneuroethicsblog.com/2014/02/neuroethics-journal-club-how-early-can.html