C. Ellie Wilson

Diagnosing prosopagnosia: Effects of ageing, sex, and participant-stimulus ethnic match on the cambridge face memory test and cambridge face perception test

The Cambridge Face Memory Test (CFMT) and Cambridge Face Perception Test (CFPT) have provided the first theoretically strong clinical tests for prosopagnosia based on novel rather than famous faces. Here, we assess the extent to which norms for these tasks must take into account ageing, sex, and testing country. Data were from Australians aged 18 to 88 years (N = 240 for CFMT; 128 for CFPT) and young adult Israelis (N = 49 for CFMT). Participants were unselected for face recognition ability; most were university educated. The diagnosis cut-off for prosopagnosia (2 SDs poorer than mean) was affected by age, participant–stimulus ethnic match (within Caucasians), and sex for middle-aged and older adults on the CFPT. We also report internal reliability, correlation between face memory and face perception, correlations with intelligence-related measures, correlation with self-report, distribution shape for the CFMT, and prevalence of developmental prosopagnosia.

Impaired holistic coding of facial expression and facial identity in congenital prosopagnosia

Research highlights ► Congenital prosopagnosics show weak holistic coding of expression and identity. ► Normal expression recognition can result from compensatory strategies. ► There may be a common stage of holistic coding for expression and identity. ► Holistic coding of identity is functionally involved in face identification ability.

Adaptive face space coding in congenital prosopagnosia: Typical figural aftereffects but abnormal identity aftereffects

People with congenital prosopagnosia (CP) report difficulty recognising faces in everyday life and perform poorly on face recognition tests. Here, we investigate whether impaired adaptive face space coding might contribute to poor face recognition in CP. To pinpoint how adaptation may affect face processing, a group of CPs and matched controls completed two complementary face adaptation tasks: the figural aftereffect, which reflects adaptation to general distortions of shape, and the identity aftereffect, which directly taps the mechanisms involved in the discrimination of different face identities. CPs displayed a typical figural aftereffect, consistent with evidence that they are able to process some shape-based information from faces, e.g., cues to discriminate sex. CPs also demonstrated a significant identity aftereffect. However, unlike controls, CPs impression of the identity of the neutral average face was not significantly shifted by adaptation, suggesting that adaptive coding of identity is abnormal in CP. In sum, CPs show reduced aftereffects but only when the task directly taps the use of face norms used to code individual identity. This finding of a reduced face identity aftereffect in individuals with severe face recognition problems is consistent with suggestions that adaptive coding may have a functional role in face recognition.

Specificity of impaired facial identity recognition in children with suspected developmental prosopagnosia

Adults experiencing face recognition difficulties in the absence of known brain injury are described as cases of developmental prosopagnosia (DP), under the assumption that specific face recognition impairments have always been present. However, only five childhood cases of DP have been reported, and the majority had additional socio-communicative impairments consistent with an autism spectrum disorder (ASD). We tested face recognition skills of six 4- to 8-year-old children, who were suspected of having DP, and tested for ASD using established diagnostic tools. Two children met criteria for ASD. One child did not exhibit consistent face recognition impairments. The remaining three children were severely impaired on multiple tasks of unfamiliar face recognition despite normal cognitive functioning and no evidence of ASD. Two of these children were also impaired at object recognition suggesting more general visual recognition problems. The final child showed normal object recognition demonstrating apparently specific problems with facial identity recognition.

Does sex influence the diagnostic evaluation of autism spectrum disorder in adults

It is unknown whether sex influences the diagnostic evaluation of autism spectrum disorder, or whether male and female adults within the spectrum have different symptom profiles. This study reports sex differences in clinical outcomes for 1244 adults (935 males and 309 females) referred for autism spectrum disorder assessment. Significantly, more males (72%) than females (66%) were diagnosed with an autism spectrum disorder of any subtype (x2 = 4.09; p = 0.04). In high-functioning autism spectrum disorder adults (IQ > 70; N = 827), there were no significant sex differences in severity of socio-communicative domain symptoms. Males had significantly more repetitive behaviours/restricted interests than females (p = 0.001, d = 0.3). A multivariate analysis of variance indicated a significant interaction between autism spectrum disorder subtype (full-autism spectrum disorder/partial-autism spectrum disorder) and sex: in full-autism spectrum disorder, males had more severe socio-communicative symptoms than females; for partial-autism spectrum disorder, the reverse was true. There were no sex differences in prevalence of co-morbid psychopathologies. Sex influenced diagnostic evaluation in a clinical sample of adults with suspected autism spectrum disorder. The sexes may present with different manifestations of the autism spectrum disorder phenotype and differences vary by diagnostic subtype. Understanding and awareness of adult female repetitive behaviours/restricted interests warrant attention and sex-specific diagnostic assessment tools may need to be considered.

Visual Scan Paths and Recognition of Facial Identity in Autism Spectrum Disorder and Typical Development

Background Previous research suggests that many individuals with autism spectrum disorder (ASD) have impaired facial identity recognition, and also exhibit abnormal visual scanning of faces. Here, two hypotheses accounting for an association between these observations were tested: i) better facial identity recognition is associated with increased gaze time on the Eye region; ii) better facial identity recognition is associated with increased eye-movements around the face. Methodology and Principal Findings Eye-movements of 11 children with ASD and 11 age-matched typically developing (TD) controls were recorded whilst they viewed a series of faces, and then completed a two alternative forced-choice recognition memory test for the faces. Scores on the memory task were standardized according to age. In both groups, there was no evidence of an association between the proportion of time spent looking at the Eye region of faces and age-standardized recognition performance, thus the first hypothesis was rejected. However, the ‘Dynamic Scanning Index’ – which was incremented each time the participant saccaded into and out of one of the core-feature interest areas – was strongly associated with age-standardized face recognition scores in both groups, even after controlling for various other potential predictors of performance. Conclusions and Significance In support of the second hypothesis, results suggested that increased saccading between core-features was associated with more accurate face recognition ability, both in typical development and ASD. Causal directions of this relationship remain undetermined.

Autism spectrum disorder in adults: diagnosis, management, and health services development

Autism spectrum disorder (ASD) is a common neurodevelopmental disorder characterized by pervasive difficulties since early childhood across reciprocal social communication and restricted, repetitive interests and behaviors. Although early ASD research focused primarily on children, there is increasing recognition that ASD is a lifelong neurodevelopmental disorder. However, although health and education services for children with ASD are relatively well established, service provision for adults with ASD is in its infancy. There is a lack of health services research for adults with ASD, including identification of comorbid health difficulties, rigorous treatment trials (pharmacological and psychological), development of new pharmacotherapies, investigation of transition and aging across the lifespan, and consideration of sex differences and the views of people with ASD. This article reviews available evidence regarding the etiology, legislation, diagnosis, management, and service provision for adults with ASD and considers what is needed to support adults with ASD as they age. We conclude that health services research for adults with ASD is urgently warranted. In particular, research is required to better understand the needs of adults with ASD, including health, aging, service development, transition, treatment options across the lifespan, sex, and the views of people with ASD. Additionally, the outcomes of recent international legislative efforts to raise awareness of ASD and service provision for adults with ASD are to be determined. Future research is required to identify high-quality, evidence-based, and cost-effective models of care. Furthermore, future health services research is also required at the beginning and end of adulthood, including improved transition from youth to adult health care and increased understanding of aging and health in older adults with ASD.

Recognition of own- and other-race faces in autism spectrum disorders

Empirical data regarding the extent of face recognition abnormalities in autism spectrum disorder (ASD) is inconsistent. Here, 27 ASD and 47 typically developing (TD) children completed an immediate two-alternative forced-choice identity matching task. We contrasted recognition of own- and other-race faces, and, counter to prediction, we found a typical advantage for recognizing own- over other-race faces in both the ASD and TD groups. In addition, ASD and TD groups responded similarly to stimulus manipulations (use of identical or different photographs for identity matching and cropping stimuli to remove hair information). However, age-standardized scores varied widely within the ASD sample, and a subgroup of ASD participants with impaired face recognition did not exhibit a significant own-race recognition advantage. An explanation regarding early experience with faces is considered, and implications for research of individual variation within ASD are discussed.

Cortical and subcortical glutathione levels in adults with autism spectrum disorder

Increased oxidative stress has been postulated to contribute to the pathogenesis of autism spectrum disorder (ASD). However, reports of alterations in oxidation markers including glutathione (GSH), the major endogenous antioxidant, are indirect, coming from blood plasma level measurements and postmortem studies. Therefore we used in‐vivo 3 Tesla proton magnetic resonance spectroscopy ([1H]MRS) to directly measure GSH concentrations in the basal ganglia (BG) and the dorsomedial prefrontal cortex of 21 normally intelligent adult males with ASD and 29 controls who did not differ in age or IQ. There was no difference in brain GSH between patients and controls in either brain area; neither did GSH levels correlate with measures of clinical severity in patients. Thus [1H]MRS measures of cortical and subcortical GSH are not a biomarker for ASD in intellectually able adult men. Autism Res 2016, 9: 429–435.

The NICE guideline on recognition, referral, diagnosis and management of adults on the autism spectrum

Purpose – This paper aims to provide an overview of the recent National Institute for Health and Clinical Excellence (NICE) clinical guidance for diagnosis and treatment of adults with Autism Spectrum Disorder (ASD) and to discuss clinical and practical implications. Design/methodology/approach – This is a summary and discussion of the NICE guidance for adults with autism. This includes discussion of relevant related guidance, the need for transition services for young people with ASD, education of professionals, applicability of the guidance to people with intellectual disabilities and challenges related to implementation of the guidance in a changing National Health Service. Findings – The guidance provides an excellent overview of current and state-of-the-art strategies for diagnosis and treatment of ASD-related behaviours, and their level of evidence. In terms of diagnosis, the main recommendation for clinicians is to carry out a comprehensive assessment for adults with suspected autism, taking into account co-morbid mental health problems and potential unmet needs. In addition, NICE makes recommendations regarding pharmacological and psychological interventions and these are discussed. The guidance also makes specific recommendations regarding service design, for example the formation of Autism Strategy Groups. This will hopefully support the development of specialist adult autism services. Originality/value – This paper provides new insights into the implications of the recently published NICE clinical guidance for autism in adults, relevant for health care professionals, service managers and service users.