Volume 16, Number 2
Divide and Conquer
Pare learning and memory to their bitty basics, and you may stand a chance against autism.
Behavioral neurologist Barry Gordon, M.D., Ph.D., and Katharina Boser, Ph.D., are a rare breed of cat in the realm of autism: They're optimists. "Guarded optimists," says Gordon, who founded Hopkins' cognitive neurology group. But the fact that he and Boser, a developmental psychologist, see all sorts and conditions of autism-children and adults, low and high functioning-and keep that outlook says things about their work. So does their ability to help some patients in ways many didn't think possible.
"Though we reduce behaviors to basics," Gordon explains, "our group's approach-which is unusual-is whole-brain. In autism, a lot goes wrong. Helping autistic children communicate means boosting a host of distinct, underlying abilities."
Boser's
work centers on language skills tied to the workings of the brain's prefrontal
cortices (PFC). "I believe that area is at the heart of autism's language
problems," she says. "The brain's fundamental storage may be intact, but
it's the accessing, the processing that has gone wrong. And that points
to prefrontal areas." Children with autism, for example, typically focus
on detail but miss the big picture. In a drawing of a baby carriage with
a small triangle on the wheel, they home in on the triangle. The same is
true with language: They may understand single words but lose the sense
of them in the context of sentences.A recent Boser study suggests some of that problem stems from inability to hold something in the mind's eye-a specific sort of short-term memory, both researchers maintain-so it can be sized up by different parts of the brain. It's like seeing parts of an elephant, holding them in mind and being able to envision the
animal.
This requires lightning shifts in attention from "local" centers on the
left side of the brain to "global" ones typically on the right-the sizing
up the PFC usually does so well. But when Boser gave her autistic subjects
such a task (see smaller inset), they had characteristic trouble.In addition to such hands-on work, Gordon's group also relies on clues from fMRI studies, EEGs and mathematical brain modeling to find autism's boundaries. "Once we identify all these behaviors," he says, "we'll be able to make a brain map of a patient's strengths and weaknesses. Then we'll use all the techniques we have to optimize what's there and try to 'sprout'
what isn't or, at least, compensate for it."
But just helping autistic children requires research projects on the side. "We're realizing how important attention and motivation are for learning," says Gordon, who finds those traits impaired in the disorder. So his approach to patients blends a close analysis of their problems with liberal rewards of M&Ms.
"One child we saw made no speech sounds. After testing, we found a profound deficit in comprehending speech. But we didn't tackle that directly. We bypassed it visually with an alternate route into his mind-we played Annie Sullivan to his Helen Keller. We've worked with him for years, building his precursors to speech, first with picture cards, then picture cards with spoken, then written words. That built up his mentation for words. Now he knows to request things verbally, a major step. And we've upped the ante. If he wants to go to the park, he needs to make a 'p' sound and can't use picture cards anymore. And he's doing it!"
In Gordon's group, bench and bedside are so intertwined that children in studies designed to shed light on autism often benefit from the applications in treatment those very studies inspire. Because this is so labor intensive, the group's patient volume isn't high, "but we're quick to see someone," says Gordon, "if we think we can make a difference."
For more information, call 410-955-7789.