Reduced Brain Connectivity in Clinical and Dimensional Autism Phenotypes Beyond Familial Confounding – A Twin Study
Abstract BackgroundPrevious studies on brain connectivity in clinical and dimensional autism have largely focused on selective connections and yielded inconsistent results. This study aimed to overcome these limitations. Global fiber tracking allowed a more unbiased assessment of white matter connectivity and utilizing a within-twin pair design introduced implicit control for genetic and environmental factors shared by twins and allowed conclusions regarding their impact. MethodsThe study examined the within-twin pair associations between structural brain connectivity of anatomically defined brain regions and both clinical autism spectrum diagnoses and dimensional autistic traits in 85 twin pairs (n=170; 56% monozygotic; 25 individuals with autism spectrum diagnosis). Structural connectivity was estimated using diffusion tensor imaging and linear regression models were fit, adjusted for IQ, other neurodevelopmental and psychiatric conditions and multiple testing. ResultsOverall, both clinical and dimensional autism phenotypes were associated with localized reductions in structural connectivity, despite comprehensively controlling for possible confounders, including all factors shared by twins. Twins fulfilling autism spectrum diagnostic criteria showed decreased brainstem-cuneus connectivity compared to their co-twins without the diagnosis. Further, twins with higher autistic traits showed decreased connectivity of the left hippocampus with the left fusiform and parahippocampal areas. These associations pointed into the same direction in mono- and dizygotic sub-cohorts, but were only significant in dizygotic twins.LimitationsThe recruitment approach of selecting primarily twin pairs discordant for autistic traits prevented a quantitative estimation of genetic and environmental contributions to brain correlates of clinical and dimensional autism. Further, assessing twins and excluding individuals with an IQ below 75 limited the generalizability of the findings. The statistical power allowed detecting medium-size or larger effects of dimensional autism. Finally, due the relatively small number of twin pairs discordant for a clinical autism, the results for clinical autism need to be interpreted with caution.ConclusionsReduced brainstem-cuneus connectivity might point towards alterations in low-level visual processing in clinical autism while reduced connectivity in networks crucial for visual and especially face processing seem to be more associated with dimensional aspects of autism. The results further suggest that the observed associations were potentially influenced by both genes and environment.