Plasticity of Brain Networks for Social Cognition in Adults with ASD

Background: The right posterior superior temporal sulcus (pSTS) / temporo-parietal junction (TPJ) is a central node in the neural systems that support action observation, social perception, and theory of mind (ToM). Abnormal function in the right pSTS/TPJ is now a well-replicated finding in autism spectrum disorder (ASD). Moreover, the degree of dysfunction in the right pSTS/TPJ is related to the severity of social dysfunction across individuals with ASD. Together, the available evidence suggests that this region may serve as a target for interventions designed to improve social cognition in ASD.

Objectives: Adopting an experimental therapeutics approach, we employed a Virtual Reality Social Cognition Training (VR-SCT) and a well-validated fMRI paradigm to target activity/connectivity in a neural system emanating from the right pSTS/TPJ in adults with ASD.

Methods: Current participants include 5 adults (M_age  = 20.18 years) with ASD (3 males) and 4 (M_age  = 25.28 years) typically developing (TD) adults (2 males). In a within-subjects pre-treatment—post-treatment design, participants viewed alternating blocks of animated geometric shapes that displayed either socially-related interactions or random movements, while lying in a 3T scanner. Behaviorally, ToM was measured at baseline and post-treatment using the Frith-Happé animations. ASD diagnoses were confirmed via expert, multi-disciplinary clinical evaluation using gold-standard research instruments including the ADOS. The TD adults did not receive intervention but were scanned twice, allowing us to: 1) evaluate test-retest reliability of measures; 2) control for the passage of time; and 3) compare treatment effects to normative activation patterns. All adults with ASD received 10 sessions of VR-SCT intervention over a 5-week period (2 sessions per week). The intervention involved a highly innovative telemedicine approach and features safe, repeatable social-skill practice through VR role-playing. The use of VR computer avatars provides adults with ASD a familiar and predictable environment, reducing their anxiety and increasing confidence in social situations.

Results: On the behavioral measures, treatment of the adults with ASD, led to improvement in ToM, replicating prior results from members of our team. At the level of neural systems, the TD adults showed decreased activation in the right pSTS/TPJ region, perhaps reflecting habituation to the novel stimuli. Strikingly, adults with ASD generally exhibited increased activation in this target region of the right pSTS/TPJ, post-treatment > pre-treatment, voxel-level Z > 1.645, cluster-level P < .05. Functional connectivity analyses revealed that within the adults with ASD, there was generally increased connectivity from the right pSTS/TPJ region to the medial prefrontal cortex (MPFC), post-treatment > pre-treatment, voxel-level Z > 1.645, cluster-level P< .05.

Conclusions: While data collection is ongoing, the current results are beginning to reveal a remarkable degree of malleability in the neural systems involved in social cognition in adults with ASD. These results reflect a novel experimental therapeutics approach and offer important implications for much-needed additional research on interventions specifically targeting neural mechanisms for social information processing in adults with ASD.