Investigation of Brain Plasticity in Autism Spectrum Disorders

Investigations of Sensorimotor Plasticity in Autism Spectrum Disorders

Individuals with autism spectrum disorders (ASD) commonly experience variances in tactile behaviors, such as hypersensitivity to light touch stimuli, altered texture discrimination, and hyporesponsivity to pain. Researchers aim to investigate the somatosensory sensitivity and sensorimotor integration utilizing novel, objective behavioral assays and TMS. The main purpose is to study brain plasticity (the changes that occur in the brain through experience) in individuals with autism spectrum disorders.

Study Overview

• Status: Recruiting
• Conditions: Autism Spectrum Disorder
• Intervention / Treatment: Behavioral: Neuropsychological Testing; Genetic: (Optional) Saliva Collection; Device: Sensory Testing; Device: Electroencephalogram (EEG); Device: Transcranial Magnetic Stimulation

Detailed Description

Individuals with autism spectrum disorders (ASD) commonly experience variances in tactile behaviors, such as hypersensitivity to light touch stimuli, altered texture discrimination and hyporesponsivity to pain. The degree of this somatosensory impairment correlates with increased anxiety behaviors as well as impairments in social behavior among ASD patients.

There remains an unmet need for suppressing the tactile hypersensitivity, which may improve anxiety and other core symptoms of ASD; however, methodologies for measuring tactile sensitivity vary widely across clinical and basic research fields. There is an urgent need for direct and objective sensory reactivity metrics in clinical studies to assess deficits in specific patient populations and for designing effective therapeutic strategies. As compared with traditional behavioral methods, the investigators propose to test novel, objective and quantitative metrics of somatosensory sensitivity in individuals with ASD.

In addition, transcranial magnetic stimulation (TMS) provides a method of measuring cortical reactivity offering the advantage of providing behaviorally independent results that are largely unaffected by attention or cognitive ability. Therefore, a TMS-based physiologic biomarker may be applicable to all individuals across the autism spectrum. A form of TMS known as paired associative stimulation (PAS) can be used to study the suggested impairment in integration of sensory input into cortical function that underlies tactile hypersensitivity in ASD. Thus, the investigators aim to investigate somatosensory sensitivity and sensorimotor integration utilizing novel, objective behavioral assays and TMS.

Participation in the study will consist of up to seven visits: one screening visit, two sensory testing visits, and two - four TMS sessions. The screening visit is expected to last between 2-3 hours, during which participants will first provide informed consent. Participants will then receive a thorough medical examination by a neurologist, and a neuropsychological evaluation (including IQ measures and ASD specific evaluations). If eligible to continue, participants will then come back for two sensory visits and two - four TMS visits that are spaced a minimum of 1 week apart.

• Study Type: Observational
• Enrollment (Anticipated): 60

Contacts and Locations

• Study Contact: Name: Paul MacMullin; Phone Number: 617-355-4875; Email: Paul.MacMullin@childrens.harvard.edu

Study Locations

• United States
  • Massachusetts
    • Boston, Massachusetts, United States, 02115
      • Recruiting
      • Boston Children's Hospital
      • Contact: Paul MacMullin; Phone Number: 617-355-4875; Email: Paul.MacMullin@childrens.harvard.edu
      • Principal Investigator: Alexander Rotenberg, MD, PhD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 6 years to 18 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

Children diagnosed with an Autism Spectrum Disorder (ASD), as well as controls.

Description

Inclusion Criteria:

• For ASD group:

  • Clinical diagnosis of a disorder on the autism spectrum according to:

    1. DSM-IV or DSM 5 criteria
    2. IQ>70 (as determined by the Abbreviated Stanford-Binet IQ)

• For the Control group:

  • No history of ASD or other developmental delay
  • No history of ASD or other developmental delay in first-degree relatives.
  • No history of clinical diagnosis of an anxiety disorder

Exclusion Criteria:

• Both ASD and Control groups:

  • Intracranial pathology, cerebral palsy, history of severe head injury, or syndromic dysmorphology
  • History of fainting spells of unknown or undetermined etiology that might constitute seizure
  • History of seizure or epilepsy
  • Chronic (particularly) uncontrolled medical conditions that may cause a medical emergency
  • Metal implants (excluding dental fillings) or devices such as pacemaker, medication pump, nerve stimulator, TENS unit, ventriculo-peritoneal shunt unless cleared by the responsible MD
  • Substance abuse or dependence within the past six months
  • Chronic treatment with prescription medications that decrease cortical seizure threshold
  • Peripheral neuropathy, as determined by the study MD during neurologic exam

• For the Control group:

  • For control participants' medical history will be reviewed for diagnoses of neurologic or psychiatric disease. If in the judgment of the investigator, the condition, e.g., depression, is well-controlled with stable medications, and does not include abnormalities of the sensory motor systems, they may be included in the study. Control participants will be excluded from taking part in the study if they have a 1st degree relative with ASD.

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Cross-Sectional

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Autism Spectrum Disorder (ASD); Individuals diagnosed with an Autism Spectrum Disorder	Behavioral: Neuropsychological Testing; Includes an IQ test, Autism Diagnostic Observation Schedule-2 (ADOS-2), and Autism Diagnostic Interview-Revised (ADI-R) assessments.; Genetic: (Optional) Saliva Collection; The sample is to test for genes (BDNF/APOE/COMT) that everyone has, but people have different varieties of these genes. Genetic testing is funded by Boston Children's Hospital.; Device: Sensory Testing; Three different tests will be completed: the tactile prepulse inhibition test (PPI) texture perception indentation testing (Mechanical Detection Threshold). Investigators will also apply mild electrical stimulation to the median nerve of the hand (on the wrist). The second sensory visit will be another version of the PPI testing involving hearing and sound.; Device: Electroencephalogram (EEG); A cap will be placed on the participants head that will be filled with electrodes (small discs). The EEG will allow investigators to measure how the brain reacts to the sensory testing.; Device: Transcranial Magnetic Stimulation; Single pulses of TMS, as well as PAS (a second type of TMS), will be applied to the cortex. There will be two - four identical TMS testing visits.
Healthy Control; Typically developing individuals without a history of autism	Behavioral: Neuropsychological Testing; Includes an IQ test, Autism Diagnostic Observation Schedule-2 (ADOS-2), and Autism Diagnostic Interview-Revised (ADI-R) assessments.; Genetic: (Optional) Saliva Collection; The sample is to test for genes (BDNF/APOE/COMT) that everyone has, but people have different varieties of these genes. Genetic testing is funded by Boston Children's Hospital.; Device: Sensory Testing; Three different tests will be completed: the tactile prepulse inhibition test (PPI) texture perception indentation testing (Mechanical Detection Threshold). Investigators will also apply mild electrical stimulation to the median nerve of the hand (on the wrist). The second sensory visit will be another version of the PPI testing involving hearing and sound.; Device: Electroencephalogram (EEG); A cap will be placed on the participants head that will be filled with electrodes (small discs). The EEG will allow investigators to measure how the brain reacts to the sensory testing.; Device: Transcranial Magnetic Stimulation; Single pulses of TMS, as well as PAS (a second type of TMS), will be applied to the cortex. There will be two - four identical TMS testing visits.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Textured novel object recognition test (NORT) and mechanical detection threshold (MDT) with von Frey hairs	To assess the validity of tactile prepulse inhibition (PPI) and other quantitative somatosensory assessments as potential biomarkers for somatosensory dysfunction in children with ASD. These metrics will provide a valuable comparison to the more-quantitative physiological measures by PAS and PPI.	3 years
Somatosensory temporal discrimination threshold (STDT) and PAS-induced modulation of motor-evoked potentials (MEPs)	To assess the validity of PAS-induced modulation of corticospinal excitability as a neurophysiologic biomarker for somatosensory dysfunction in children with ASD.	3 years

Collaborators and Investigators

• Sponsor: Boston Children's Hospital
• Collaborators: National Institute of Mental Health (NIMH); Simons Foundation Autism Research Initiative (SFARI)
• Investigators: Principal Investigator: Alexander Rotenberg, MD, PhD, Alexander.Rotenberg@childrens.harvard.edu

Study record dates

Study Major Dates

• Study Start (Actual): June 10, 2019
• Primary Completion (Anticipated): May 1, 2022
• Study Completion (Anticipated): May 1, 2022

Study Registration Dates

• First Submitted: January 11, 2021
• First Submitted That Met QC Criteria: January 11, 2021
• First Posted (Actual): January 12, 2021

Study Record Updates

• Last Update Posted (Actual): November 5, 2021
• Last Update Submitted That Met QC Criteria: November 4, 2021
• Last Verified: November 1, 2021

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Mental Disorders; Neurodevelopmental Disorders; Autistic Disorder; Autism Spectrum Disorder; Child Development Disorders, Pervasive
• Other Study ID Numbers: IRB-P00027556; R21MH120438 (U.S. NIH Grant/Contract)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No