Altered reward system reactivity for personalized circumscribed interests in autism

Abstract Background Neurobiological research in autism spectrum disorders (ASD) has paid little attention on brain mechanisms that cause and maintain restricted and repetitive behaviors and interests (RRBIs). Evidence indicates an imbalance in the brain’s reward system responsiveness to social and non-social stimuli may contribute to both social deficits and RRBIs. Thus, this study’s central aim was to compare brain responsiveness to individual RRBI (i.e., circumscribed interests), with social rewards (i.e., social approval), in youth with ASD relative to typically developing controls (TDCs). Methods We conducted a 3T functional magnetic resonance imaging (fMRI) study to investigate the blood-oxygenation-level-dependent effect of personalized circumscribed interest rewards versus social rewards in 39 youth with ASD relative to 22 TDC. To probe the reward system, we employed short video clips as reinforcement in an instrumental incentive delay task. This optimization increased the task’s ecological validity compared to still pictures that are often used in this line of research. Results Compared to TDCs, youth with ASD had stronger reward system responses for CIs mostly within the non-social realm (e.g., video games) than social rewards (e.g., approval). Additionally, this imbalance within the caudate nucleus’ responsiveness was related to greater social impairment. Conclusions The current data support the idea of reward system dysfunction that may contribute to enhanced motivation for RRBIs in ASD, accompanied by diminished motivation for social engagement. If a dysregulated reward system indeed supports the emergence and maintenance of social and non-social symptoms of ASD, then strategically targeting the reward system in future treatment endeavors may allow for more efficacious treatment practices that help improve outcomes for individuals with ASD and their families

Behavioral therapies.

Intervention for the core symptoms and comorbid conditions associated with autism spectrum disorder (ASD) primarily involves behavioral and/or cognitive behavioral therapy. This chapter reviews the relevant research for the effectiveness of these approaches across several areas. It begins with a review of the rapidly growing research focused on early intervention for young children with ASD. Next, interventions for persons on the severe end of the autism spectrum are discussed. Specifically, studies focus either on symptomatic treatment (e.g., increasing social skills) or on packages of treatments that are designed to address the range of difficulties persons with ASD display. The chapter then describes the nascent research on persons on the milder end of the spectrum—especially work on social skills training. Finally, a growing research base on treating comorbid conditions (e.g., anxiety, sleep problems) is also briefly reviewed. A theme throughout the chapter is the need to individualize treatment and the special needs of the range of persons with ASD